NHDR Implementation Guide Release 1.0
0.1.0 - ci-build
NHDR Implementation Guide Release 1.0, published by NHDR. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/PROJ-PHILHEALTH-EA-NHDR/PhilHealth-NHDR-IG-Review/ and changes regularly. See the Directory of published versions
Official URL: https://nhdr.gov.ph/fhir/StructureDefinition/PH-Coverage | Version: 0.1.0 | |||
Standards status: Draft | Computable Name: PH_Coverage | |||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
Usages:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
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0..* | Coverage | Insurance or medical plan or a payment agreement | |
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?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
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Σ | 1..1 | Reference(Patient) | Plan beneficiary |
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Σ | 1..* | Reference(PH Organization | PH Patient) | Issuer of the policy |
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Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | 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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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1..* | Reference(PH Organization | PH Patient) | Issuer of the policy | |
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..1 | CodeableConcept | Cost category Binding: Coverage Copay Type (required) | |
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1..1 | Money | The amount or percentage due from the beneficiary | |
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0..0 | |||
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0..0 | |||
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0..0 | |||
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Path | Conformance | ValueSet | URI |
Coverage.costToBeneficiary.type | required | CoverageCopayTypeVShttps://nhdr.gov.ph/fhir/ValueSet/CoverageCoPayTypeVS From this IG |
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact |
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Σ | 0..1 | Meta | Metadata about the resource |
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Σ | 0..* | Identifier | Business Identifier for the coverage |
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?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | Plan beneficiary |
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Σ | 0..1 | Period | Coverage start and end dates |
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Σ | 1..* | Reference(PH Organization | PH Patient) | Issuer of the policy |
![]() ![]() ![]() |
0..* | BackboneElement | Additional coverage classifications | |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type |
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0..* | BackboneElement | Patient payments for services/products | |
![]() ![]() ![]() ![]() |
Σ | 0..1 | CodeableConcept | Cost category Binding: Coverage Copay Type (required) |
![]() ![]() ![]() ![]() |
Σ | 1..1 | Money | The amount or percentage due from the beneficiary |
![]() |
Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard | |
Coverage.type | preferred | CoverageTypeAndSelf-PayCodeshttp://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard | |
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard | |
Coverage.costToBeneficiary.type | required | CoverageCopayTypeVShttps://nhdr.gov.ph/fhir/ValueSet/CoverageCoPayTypeVS From this IG | |
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | 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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Coverage
Key Elements View
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() ![]() |
Σ | 1..* | Reference(PH Organization | PH Patient) | Issuer of the policy |
![]() |
Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | 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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
Differential View
This structure is derived from Coverage
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() |
0..0 | |||
![]() ![]() ![]() |
0..0 | |||
![]() ![]() ![]() |
0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
![]() ![]() ![]() |
0..0 | |||
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0..0 | |||
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1..* | Reference(PH Organization | PH Patient) | Issuer of the policy | |
![]() ![]() ![]() |
||||
![]() ![]() ![]() ![]() |
0..0 | |||
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0..0 | |||
![]() ![]() ![]() ![]() |
0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
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0..0 | |||
![]() ![]() ![]() ![]() |
0..1 | CodeableConcept | Cost category Binding: Coverage Copay Type (required) | |
![]() ![]() ![]() ![]() |
1..1 | Money | The amount or percentage due from the beneficiary | |
![]() ![]() ![]() ![]() |
0..0 | |||
![]() ![]() ![]() |
0..0 | |||
![]() ![]() ![]() |
0..0 | |||
![]() |
Path | Conformance | ValueSet | URI |
Coverage.costToBeneficiary.type | required | CoverageCopayTypeVShttps://nhdr.gov.ph/fhir/ValueSet/CoverageCoPayTypeVS From this IG |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints Filter: ![]() ![]() |
---|---|---|---|---|
![]() ![]() |
0..* | Coverage | Insurance or medical plan or a payment agreement | |
![]() ![]() ![]() |
Σ | 0..1 | id | Logical id of this artifact |
![]() ![]() ![]() |
Σ | 0..1 | Meta | Metadata about the resource |
![]() ![]() ![]() |
Σ | 0..* | Identifier | Business Identifier for the coverage |
![]() ![]() ![]() |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
![]() ![]() ![]() |
Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. |
![]() ![]() ![]() |
Σ | 1..1 | Reference(Patient) | Plan beneficiary |
![]() ![]() ![]() |
Σ | 0..1 | Period | Coverage start and end dates |
![]() ![]() ![]() |
Σ | 1..* | Reference(PH Organization | PH Patient) | Issuer of the policy |
![]() ![]() ![]() |
0..* | BackboneElement | Additional coverage classifications | |
![]() ![]() ![]() ![]() |
Σ | 1..1 | CodeableConcept | Type of class such as 'group' or 'plan' Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc. |
![]() ![]() ![]() ![]() |
Σ | 1..1 | string | Value associated with the type |
![]() ![]() ![]() |
0..* | BackboneElement | Patient payments for services/products | |
![]() ![]() ![]() ![]() |
Σ | 0..1 | CodeableConcept | Cost category Binding: Coverage Copay Type (required) |
![]() ![]() ![]() ![]() |
Σ | 1..1 | Money | The amount or percentage due from the beneficiary |
![]() |
Path | Conformance | ValueSet | URI |
Coverage.status | required | FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.0.1 From the FHIR Standard | |
Coverage.type | preferred | CoverageTypeAndSelf-PayCodeshttp://hl7.org/fhir/ValueSet/coverage-type From the FHIR Standard | |
Coverage.class.type | extensible | CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class From the FHIR Standard | |
Coverage.costToBeneficiary.type | required | CoverageCopayTypeVShttps://nhdr.gov.ph/fhir/ValueSet/CoverageCoPayTypeVS From this IG | |
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception From the FHIR Standard |
Id | Grade | Path(s) | Details | Requirements |
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() | |
dom-3 | error | Coverage | 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 : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() | |
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() | |
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() | |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() | |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) | |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |
This structure is derived from Coverage
Other representations of profile: CSV, Excel, Schematron