Профиль Core Coverage ресурса Coverage отражает национальные требования к учету взаимоотношений между медицинской организацией и плательщиками при оплате медицинской помощи. • Использование справочников НСИ МЗ РФ для указания источника оплаты и документа-основания оплаты

Профиль может быть использован при передаче информации о медицинской помощи, которая предполагает оплату в рамках систем обязательного страхования, добровольного страхования, за счет средств пациента или иных физических или юридических лиц.

//пример требует исправления: у него идентификатор ОМСный, а плательщик – сам пациент

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Slices for identifier		0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:OMS		0..1	Identifier	Полис ОМС- обязательного медицинского страхования
type		1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/OMS
identifier:DMS		0..1	Identifier	Полис ДМС - добровольного медицинского страхования
type		1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/DMS
identifier:Contract		0..1	Identifier	Договор на оказание платных медицинских услугя
type		1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 3
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/Contract
type		0..1	CodeableConcept	Тип страхового покрытия. Binding: Core_Vs_Nsi_Sources_Of_Paymente(required) Справочник НСИ Минздрава Источники оплаты медицинской помощи
beneficiary		1..1	Reference(Core Patient (Пациент))	Ссылка на пациента
payor		1..*	Reference(Core Organisation Payer (Организация-плательщик) | Core Patient Payer (Пациент - плательщик) | Core Related Person (Лицо, имеющее связь с пациентом) | Core Related Person Payer (Лицо-плательщик, имеющее связь с пациентом))	Плательщик: пациент, родственник или организация
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet / Code	URI
Coverage.identifier:OMS.type	required	Pattern: 1 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:DMS.type	required	Pattern: 2 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:Contract.type	required	Pattern: 3 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:OMS	Σ	0..1	Identifier	Полис ОМС- обязательного медицинского страхования
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/OMS
identifier:DMS	Σ	0..1	Identifier	Полис ДМС - добровольного медицинского страхования
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/DMS
identifier:Contract	Σ	0..1	Identifier	Договор на оказание платных медицинских услугя
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 3
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/Contract
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Тип страхового покрытия. Binding: Core_Vs_Nsi_Sources_Of_Paymente(required) Справочник НСИ Минздрава Источники оплаты медицинской помощи 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.
beneficiary	Σ	1..1	Reference(Core Patient (Пациент))	Ссылка на пациента
payor	Σ	1..*	Reference(Core Organisation Payer (Организация-плательщик) | Core Patient Payer (Пациент - плательщик) | Core Related Person (Лицо, имеющее связь с пациентом) | Core Related Person Payer (Лицо-плательщик, имеющее связь с пациентом))	Плательщик: пациент, родственник или организация
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.identifier:OMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:OMS.type	required	Pattern: 1 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:DMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:DMS.type	required	Pattern: 2 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:Contract.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:Contract.type	required	Pattern: 3 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard

Constraints

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.exists() and ('#'+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(uri) = '#').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()

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
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
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources dom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:OMS	Σ	0..1	Identifier	Полис ОМС- обязательного медицинского страхования
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) 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		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1
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
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/OMS
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:DMS	Σ	0..1	Identifier	Полис ДМС - добровольного медицинского страхования
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) 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		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2
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
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/DMS
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:Contract	Σ	0..1	Identifier	Договор на оказание платных медицинских услугя
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) 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		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 3
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
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/Contract
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Тип страхового покрытия. Binding: Core_Vs_Nsi_Sources_Of_Paymente(required) Справочник НСИ Минздрава Источники оплаты медицинской помощи 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.
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	Σ	1..1	Reference(Core Patient (Пациент))	Ссылка на пациента
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..*	Reference(Core Organisation Payer (Организация-плательщик) | Core Patient Payer (Пациент - плательщик) | Core Related Person (Лицо, имеющее связь с пациентом) | Core Related Person Payer (Лицо-плательщик, имеющее связь с пациентом))	Плательщик: пациент, родственник или организация
class		0..*	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.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.identifier:OMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:OMS.type	required	Pattern: 1 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:DMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:DMS.type	required	Pattern: 2 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:Contract.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:Contract.type	required	Pattern: 3 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

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.exists() and ('#'+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(uri) = '#').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()
dom-r4b	warning	Coverage.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems : ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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()

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Slices for identifier		0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:OMS		0..1	Identifier	Полис ОМС- обязательного медицинского страхования
type		1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/OMS
identifier:DMS		0..1	Identifier	Полис ДМС - добровольного медицинского страхования
type		1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/DMS
identifier:Contract		0..1	Identifier	Договор на оказание платных медицинских услугя
type		1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 3
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/Contract
type		0..1	CodeableConcept	Тип страхового покрытия. Binding: Core_Vs_Nsi_Sources_Of_Paymente(required) Справочник НСИ Минздрава Источники оплаты медицинской помощи
beneficiary		1..1	Reference(Core Patient (Пациент))	Ссылка на пациента
payor		1..*	Reference(Core Organisation Payer (Организация-плательщик) | Core Patient Payer (Пациент - плательщик) | Core Related Person (Лицо, имеющее связь с пациентом) | Core Related Person Payer (Лицо-плательщик, имеющее связь с пациентом))	Плательщик: пациент, родственник или организация
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet / Code	URI
Coverage.identifier:OMS.type	required	Pattern: 1 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:DMS.type	required	Pattern: 2 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:Contract.type	required	Pattern: 3 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:OMS	Σ	0..1	Identifier	Полис ОМС- обязательного медицинского страхования
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/OMS
identifier:DMS	Σ	0..1	Identifier	Полис ДМС - добровольного медицинского страхования
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/DMS
identifier:Contract	Σ	0..1	Identifier	Договор на оказание платных медицинских услугя
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 3
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/Contract
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Тип страхового покрытия. Binding: Core_Vs_Nsi_Sources_Of_Paymente(required) Справочник НСИ Минздрава Источники оплаты медицинской помощи 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.
beneficiary	Σ	1..1	Reference(Core Patient (Пациент))	Ссылка на пациента
payor	Σ	1..*	Reference(Core Organisation Payer (Организация-плательщик) | Core Patient Payer (Пациент - плательщик) | Core Related Person (Лицо, имеющее связь с пациентом) | Core Related Person Payer (Лицо-плательщик, имеющее связь с пациентом))	Плательщик: пациент, родственник или организация
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.identifier:OMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:OMS.type	required	Pattern: 1 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:DMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:DMS.type	required	Pattern: 2 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:Contract.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:Contract.type	required	Pattern: 3 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard

Constraints

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.exists() and ('#'+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(uri) = '#').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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
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
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): IETF language tag Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources dom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business Identifier for the coverage Slice: Unordered, Open by value:system
identifier:OMS	Σ	0..1	Identifier	Полис ОМС- обязательного медицинского страхования
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) 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		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1
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
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/OMS
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:DMS	Σ	0..1	Identifier	Полис ДМС - добровольного медицинского страхования
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) 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		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 2
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
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/DMS
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:Contract	Σ	0..1	Identifier	Договор на оказание платных медицинских услугя
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required)
type	Σ	1..1	CodeableConcept	Тип идентификатора, кодируется по НСИ Binding: Core ValueSet NSI coverage document (документы-основания для оплаты медицинских услуг) (required) 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		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.ru/ig/core/CodeSystem/core-cs-nsi-coverage-document
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 3
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
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/core/systems/Contract
value	Σ	0..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type	Σ	0..1	CodeableConcept	Тип страхового покрытия. Binding: Core_Vs_Nsi_Sources_Of_Paymente(required) Справочник НСИ Минздрава Источники оплаты медицинской помощи 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.
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	Σ	1..1	Reference(Core Patient (Пациент))	Ссылка на пациента
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..*	Reference(Core Organisation Payer (Организация-плательщик) | Core Patient Payer (Пациент - плательщик) | Core Related Person (Лицо, имеющее связь с пациентом) | Core Related Person Payer (Лицо-плательщик, имеющее связь с пациентом))	Плательщик: пациент, родственник или организация
class		0..*	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.
value	Σ	1..1	string	Value associated with the type
name	Σ	0..1	string	Human readable description of the type and value
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
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.identifier:OMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:OMS.type	required	Pattern: 1 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:DMS.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:DMS.type	required	Pattern: 2 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.identifier:Contract.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.3.0 from the FHIR Standard
Coverage.identifier:Contract.type	required	Pattern: 3 https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document from this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.3.0 from the FHIR Standard
Coverage.type	preferred	CoverageTypeAndSelf-PayCodes http://hl7.org/fhir/ValueSet/coverage-type from the FHIR Standard
Coverage.relationship	extensible	SubscriberRelationshipCodes http://hl7.org/fhir/ValueSet/subscriber-relationship from the FHIR Standard
Coverage.class.type	extensible	CoverageClassCodes http://hl7.org/fhir/ValueSet/coverage-class from the FHIR Standard
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes http://hl7.org/fhir/ValueSet/coverage-copay-type from the FHIR Standard
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes http://hl7.org/fhir/ValueSet/coverage-financial-exception from the FHIR Standard

Constraints

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.exists() and ('#'+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(uri) = '#').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()
dom-r4b	warning	Coverage.contained	Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems : ($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic)
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

Summary

Mandatory: 0 element(6 nested mandatory elements)

Structures

This structure refers to these other structures:

• Core Patient (Пациент) (https://fhir.ru/ig/core/StructureDefinition/core-patient)
• Core Organisation Payer (Организация-плательщик) (https://fhir.ru/ig/core/StructureDefinition/core-organization-payer)
• Core Patient Payer (Пациент - плательщик) (https://fhir.ru/ig/core/StructureDefinition/core-patient-payer)
• Core Related Person (Лицо, имеющее связь с пациентом) (https://fhir.ru/ig/core/StructureDefinition/core-related-person)
• Core Related Person Payer (Лицо-плательщик, имеющее связь с пациентом) (https://fhir.ru/ig/core/StructureDefinition/core-related-person-payer)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Coverage.identifier