Mensaje TEI - APS a nivel secundario
0.1.0 - ci-build

Mensaje TEI - APS a nivel secundario, published by CENS. 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/cens-chile/tei-aps-secundario/ and changes regularly. See the Directory of published versions

Resource Profile: Prevision

Official URL: https://interoperabilidad.minsal.cl/fhir/ig/tei-aps-secundario/StructureDefinition/Prevision Version: 0.1.0
Draft as of 2025-10-01 Computable Name: Prevision

Perfil para la determinación de previsiones en Chile

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage Insurance or medical plan or a payment agreement
Constraints: tramo-fonasa
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:Prais S 0..1 boolean Prais
URL: https://interoperabilidad.minsal.cl/fhir/ig/tei-aps-secundario/StructureDefinition/ExtensionBoolPrais
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣ 1..1 CodeableConcept Tipo de Previsión
Binding: VS Prevision (required)
.... coding Σ 1..1 Coding Code defined by a terminology system
..... code Σ 1..1 code Código de la previsión segun Norma 231
..... display Σ 1..1 string Glosa asociada al código
.... text Σ 0..1 string Descripción de previsión
... beneficiary SΣ 1..1 Reference(Patient LE) Referencia al recurso paciente asociado a la previsión
... payor Σ 1..1 Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... display Σ 1..1 string Fonasa, Isapre, Particular
... class 0..1 BackboneElement Additional coverage classifications
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 0..1 uri Identity of the terminology system
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: class
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... value Σ 1..1 string Tramo FONASA o Nombre Isapre
.... name Σ 1..1 string Descripción: Fonasa Tramo A o Isapre Los Palermos

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required VS Prevision 📦0.1.0 This IG
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()
tramo-fonasa error Coverage Si tipo(type) es (01)Fonasa, se debe definir el tramo(class). If type.coding.code = 01 class SHALL be present (type.code = '01' and class.exists() and (class.value = 'A' or class.value = 'B' or class.value = 'C' or class.value = 'D'))

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage Insurance or medical plan or a payment agreement
Constraints: tramo-fonasa
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:Prais S 0..1 boolean Prais
URL: https://interoperabilidad.minsal.cl/fhir/ig/tei-aps-secundario/StructureDefinition/ExtensionBoolPrais
... status S 1..1 code Estado de la previsión active | cancelled | draft | entered-in-error,
Binding: FinancialResourceStatusCodes (required): Códigos requeridos por estándar
Required Pattern: active
... type S 1..1 CodeableConcept Tipo de Previsión
Binding: VS Prevision (required)
.... coding 1..1 Coding Code defined by a terminology system
..... code 1..1 code Código de la previsión segun Norma 231
..... display 1..1 string Glosa asociada al código
.... text 0..1 string Descripción de previsión
... payor 1..1 Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... display 1..1 string Fonasa, Isapre, Particular
... class 0..1 BackboneElement Additional coverage classifications
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: class
.... value 1..1 string Tramo FONASA o Nombre Isapre
.... name 1..1 string Descripción: Fonasa Tramo A o Isapre Los Palermos

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required VS Prevision 📦0.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
tramo-fonasa error Coverage Si tipo(type) es (01)Fonasa, se debe definir el tramo(class). If type.coding.code = 01 class SHALL be present (type.code = '01' and class.exists() and (class.value = 'A' or class.value = 'B' or class.value = 'C' or class.value = 'D'))
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage Insurance or medical plan or a payment agreement
Constraints: tramo-fonasa
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:Prais S 0..1 boolean Prais
URL: https://interoperabilidad.minsal.cl/fhir/ig/tei-aps-secundario/StructureDefinition/ExtensionBoolPrais
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code Estado de la previsión active | cancelled | draft | entered-in-error,
Binding: FinancialResourceStatusCodes (required): Códigos requeridos por estándar
Required Pattern: active
... type SΣ 1..1 CodeableConcept Tipo de Previsión
Binding: VS Prevision (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 1..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 0..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Código de la previsión segun Norma 231
..... display Σ 1..1 string Glosa asociada al código
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Descripción de previsión
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(Patient LE) Referencia al recurso paciente asociado a la previsión
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..1 Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 1..1 string Fonasa, Isapre, Particular
... class 0..1 BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 0..1 uri Identity of the terminology system
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: class
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... value Σ 1..1 string Tramo FONASA o Nombre Isapre
.... name Σ 1..1 string Descripción: Fonasa Tramo A o Isapre Los Palermos
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required VS Prevision 📦0.1.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.payor.type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()
tramo-fonasa error Coverage Si tipo(type) es (01)Fonasa, se debe definir el tramo(class). If type.coding.code = 01 class SHALL be present (type.code = '01' and class.exists() and (class.value = 'A' or class.value = 'B' or class.value = 'C' or class.value = 'D'))

This structure is derived from Coverage

Summary

Mandatory: 5 elements(1 nested mandatory element)
Must-Support: 4 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage Insurance or medical plan or a payment agreement
Constraints: tramo-fonasa
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:Prais S 0..1 boolean Prais
URL: https://interoperabilidad.minsal.cl/fhir/ig/tei-aps-secundario/StructureDefinition/ExtensionBoolPrais
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type SΣ 1..1 CodeableConcept Tipo de Previsión
Binding: VS Prevision (required)
.... coding Σ 1..1 Coding Code defined by a terminology system
..... code Σ 1..1 code Código de la previsión segun Norma 231
..... display Σ 1..1 string Glosa asociada al código
.... text Σ 0..1 string Descripción de previsión
... beneficiary SΣ 1..1 Reference(Patient LE) Referencia al recurso paciente asociado a la previsión
... payor Σ 1..1 Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... display Σ 1..1 string Fonasa, Isapre, Particular
... class 0..1 BackboneElement Additional coverage classifications
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 0..1 uri Identity of the terminology system
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: class
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... value Σ 1..1 string Tramo FONASA o Nombre Isapre
.... name Σ 1..1 string Descripción: Fonasa Tramo A o Isapre Los Palermos

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required VS Prevision 📦0.1.0 This IG
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()
tramo-fonasa error Coverage Si tipo(type) es (01)Fonasa, se debe definir el tramo(class). If type.coding.code = 01 class SHALL be present (type.code = '01' and class.exists() and (class.value = 'A' or class.value = 'B' or class.value = 'C' or class.value = 'D'))

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage Insurance or medical plan or a payment agreement
Constraints: tramo-fonasa
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:Prais S 0..1 boolean Prais
URL: https://interoperabilidad.minsal.cl/fhir/ig/tei-aps-secundario/StructureDefinition/ExtensionBoolPrais
... status S 1..1 code Estado de la previsión active | cancelled | draft | entered-in-error,
Binding: FinancialResourceStatusCodes (required): Códigos requeridos por estándar
Required Pattern: active
... type S 1..1 CodeableConcept Tipo de Previsión
Binding: VS Prevision (required)
.... coding 1..1 Coding Code defined by a terminology system
..... code 1..1 code Código de la previsión segun Norma 231
..... display 1..1 string Glosa asociada al código
.... text 0..1 string Descripción de previsión
... payor 1..1 Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... display 1..1 string Fonasa, Isapre, Particular
... class 0..1 BackboneElement Additional coverage classifications
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: class
.... value 1..1 string Tramo FONASA o Nombre Isapre
.... name 1..1 string Descripción: Fonasa Tramo A o Isapre Los Palermos

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required VS Prevision 📦0.1.0 This IG

Constraints

Id Grade Path(s) Description Expression
tramo-fonasa error Coverage Si tipo(type) es (01)Fonasa, se debe definir el tramo(class). If type.coding.code = 01 class SHALL be present (type.code = '01' and class.exists() and (class.value = 'A' or class.value = 'B' or class.value = 'C' or class.value = 'D'))

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage C 0..* Coverage Insurance or medical plan or a payment agreement
Constraints: tramo-fonasa
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:Prais S 0..1 boolean Prais
URL: https://interoperabilidad.minsal.cl/fhir/ig/tei-aps-secundario/StructureDefinition/ExtensionBoolPrais
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code Estado de la previsión active | cancelled | draft | entered-in-error,
Binding: FinancialResourceStatusCodes (required): Códigos requeridos por estándar
Required Pattern: active
... type SΣ 1..1 CodeableConcept Tipo de Previsión
Binding: VS Prevision (required)
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 1..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 0..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 1..1 code Código de la previsión segun Norma 231
..... display Σ 1..1 string Glosa asociada al código
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Descripción de previsión
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber Σ 0..1 Reference(Patient | RelatedPerson) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary SΣ 1..1 Reference(Patient LE) Referencia al recurso paciente asociado a la previsión
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..1 Reference(Organization | Patient | RelatedPerson) Issuer of the policy
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 1..1 string Fonasa, Isapre, Particular
... class 0..1 BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (Complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 0..1 uri Identity of the terminology system
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: class
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... value Σ 1..1 string Tramo FONASA o Nombre Isapre
.... name Σ 1..1 string Descripción: Fonasa Tramo A o Isapre Los Palermos
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📦4.0.1 FHIR Std.
Coverage.type Base required VS Prevision 📦0.1.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.payor.type Base extensible ResourceType 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
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()
tramo-fonasa error Coverage Si tipo(type) es (01)Fonasa, se debe definir el tramo(class). If type.coding.code = 01 class SHALL be present (type.code = '01' and class.exists() and (class.value = 'A' or class.value = 'B' or class.value = 'C' or class.value = 'D'))

This structure is derived from Coverage

Summary

Mandatory: 5 elements(1 nested mandatory element)
Must-Support: 4 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

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