Core_Coverage — Профиль страхового покрытия

Принятые решения по профилированию

Описание профиля

Профиль Core_Coverage расширяет стандартный ресурс Coverage для поддержки российских требований:

• Использование справочника НСИ МЗ РФ для типов источников оплаты
• Поддержка идентификаторов полисов ОМС с указанием типа полиса
• Связь с пациентом через профиль Core_Patient

Используемые справочники и системы идентификации

• НСИ МЗ РФ — Источники оплаты (CodeSystem)
• НСИ МЗ РФ — Источники оплаты (ValueSet)
• НСИ МЗ РФ — Типы полисов ОМС (CodeSystem)
• НСИ МЗ РФ — Типы полисов ОМС (ValueSet)

FSH-код профиля

Profile: Core_Coverage
Parent: Coverage
Id: core-coverage
Title: "Core Coverage (Страховое покрытие)"
Description: "Базовый профиль страхового покрытия для российских FHIR-реализаций"

* type from https://fhir.ru/ig/core/ValueSet/core-vs-nsi-sources-of-payment (required)

* identifier contains
    omsPolicy 0..1 and
    omsType 0..1

* identifier[omsPolicy] ^short = "Полис ОМС"

* identifier[omsType] ^short = "Тип полиса ОМС"
* identifier[omsType].type.coding from https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document-oms (required)

* beneficiary only Reference(Core_Patient)

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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
contained		0..*	Resource	Contained, inline Resources
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier(s) for this coverage Slice: Unordered, Open by value:system
identifier:omsPolicy	Σ	0..1	Identifier	Документ, подтверждающий страховку по ОМС
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:hl7Type	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
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: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
coding:omsType	Σ	1..1	Coding	Тип полиса ОМС по справочнику НСИ МЗ РФ
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.643.5.1.13.13.99.2.245
code	ΣC	1..1	code	Symbol in syntax defined by the system Binding: Core ValueSet Типы полисов ОМС (required)
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/ig/core/systems/oms
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
type	Σ	0..1	CodeableConcept	Тип источника оплаты Binding: Core ValueSet Источники оплаты (required)
beneficiary	Σ	1..1	Reference(Core Patient (Пациент))	Бенефициар
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.identifier:omsPolicy.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 From the FHIR Standard
Coverage.identifier:omsPolicy.type	extensible	IdentifierTypeCodes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Coverage.identifier:omsPolicy.type.coding:omsType.code	required	Core_Vs_Nsi_Coverage_Document_OMS(a valid code from Core CodeSystem Типы полисов ОМС) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document-oms From this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 From the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 From the FHIR Standard
Coverage.type	required	Core_Vs_Nsi_Sources_Of_Payment(a valid code from Core CodeSystem Источники финансирования) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-sources-of-payment From this IG

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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Slices for identifier		0..*	Identifier	Business identifier(s) for this coverage Slice: Unordered, Open by value:system
identifier:omsPolicy		0..1	Identifier	Документ, подтверждающий страховку по ОМС
type		1..1	CodeableConcept	Description of identifier
Slices for coding		2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:hl7Type		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SB
coding:omsType		1..1	Coding	Тип полиса ОМС по справочнику НСИ МЗ РФ
system		1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.643.5.1.13.13.99.2.245
code		1..1	code	Symbol in syntax defined by the system Binding: Core ValueSet Типы полисов ОМС (required)
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/ig/core/systems/oms
type		0..1	CodeableConcept	Тип источника оплаты Binding: Core ValueSet Источники оплаты (required)
beneficiary		1..1	Reference(Core Patient (Пациент))	Бенефициар
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.identifier:omsPolicy.type.coding:omsType.code	required	Core_Vs_Nsi_Coverage_Document_OMS(a valid code from Core CodeSystem Типы полисов ОМС) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document-oms From this IG
Coverage.type	required	Core_Vs_Nsi_Sources_Of_Payment(a valid code from Core CodeSystem Источники финансирования) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-sources-of-payment From this IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier(s) for this coverage Slice: Unordered, Open by value:system
identifier:omsPolicy	Σ	0..1	Identifier	Документ, подтверждающий страховку по ОМС
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): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:hl7Type	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
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: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
coding:omsType	Σ	1..1	Coding	Тип полиса ОМС по справочнику НСИ МЗ РФ
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.643.5.1.13.13.99.2.245
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	1..1	code	Symbol in syntax defined by the system Binding: Core ValueSet Типы полисов ОМС (required)
display	ΣC	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	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/ig/core/systems/oms
value	ΣC	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.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
paymentBy		0..*	BackboneElement	Self-pay parties and responsibility
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
party	Σ	1..1	Reference(Patient | RelatedPerson | Organization)	Parties performing self-payment
responsibility	Σ	0..1	string	Party's responsibility
type	Σ	0..1	CodeableConcept	Тип источника оплаты Binding: Core ValueSet Источники оплаты (required)
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..*	Identifier	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(Core Patient (Пациент))	Бенефициар
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
insurer	Σ	0..1	Reference(Organization)	Issuer of the policy
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, e.g. Group, Plan, Class, etc.
value	Σ	1..1	Identifier	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.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example)
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example)
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example)
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example)
value[x]	Σ	0..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
insurancePlan		0..1	Reference(InsurancePlan)	Insurance plan details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 From the FHIR Standard
Coverage.identifier:omsPolicy.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 From the FHIR Standard
Coverage.identifier:omsPolicy.type	extensible	IdentifierTypeCodes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Coverage.identifier:omsPolicy.type.coding:omsType.code	required	Core_Vs_Nsi_Coverage_Document_OMS(a valid code from Core CodeSystem Типы полисов ОМС) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document-oms From this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 From the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 From the FHIR Standard
Coverage.type	required	Core_Vs_Nsi_Sources_Of_Payment(a valid code from Core CodeSystem Источники финансирования) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-sources-of-payment From this IG
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.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Coverage.costToBeneficiary.network	example	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network From the FHIR Standard
Coverage.costToBeneficiary.unit	example	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit From the FHIR Standard
Coverage.costToBeneficiary.term	example	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term 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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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
contained		0..*	Resource	Contained, inline Resources
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier(s) for this coverage Slice: Unordered, Open by value:system
identifier:omsPolicy	Σ	0..1	Identifier	Документ, подтверждающий страховку по ОМС
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:hl7Type	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
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: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
coding:omsType	Σ	1..1	Coding	Тип полиса ОМС по справочнику НСИ МЗ РФ
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.643.5.1.13.13.99.2.245
code	ΣC	1..1	code	Symbol in syntax defined by the system Binding: Core ValueSet Типы полисов ОМС (required)
system	Σ	1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/ig/core/systems/oms
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
type	Σ	0..1	CodeableConcept	Тип источника оплаты Binding: Core ValueSet Источники оплаты (required)
beneficiary	Σ	1..1	Reference(Core Patient (Пациент))	Бенефициар
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.identifier:omsPolicy.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 From the FHIR Standard
Coverage.identifier:omsPolicy.type	extensible	IdentifierTypeCodes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Coverage.identifier:omsPolicy.type.coding:omsType.code	required	Core_Vs_Nsi_Coverage_Document_OMS(a valid code from Core CodeSystem Типы полисов ОМС) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document-oms From this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 From the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 From the FHIR Standard
Coverage.type	required	Core_Vs_Nsi_Sources_Of_Payment(a valid code from Core CodeSystem Источники финансирования) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-sources-of-payment From this IG

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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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()

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
Slices for identifier		0..*	Identifier	Business identifier(s) for this coverage Slice: Unordered, Open by value:system
identifier:omsPolicy		0..1	Identifier	Документ, подтверждающий страховку по ОМС
type		1..1	CodeableConcept	Description of identifier
Slices for coding		2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:hl7Type		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SB
coding:omsType		1..1	Coding	Тип полиса ОМС по справочнику НСИ МЗ РФ
system		1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.643.5.1.13.13.99.2.245
code		1..1	code	Symbol in syntax defined by the system Binding: Core ValueSet Типы полисов ОМС (required)
system		1..1	uri	The namespace for the identifier value Required Pattern: http://fhir.ru/ig/core/systems/oms
type		0..1	CodeableConcept	Тип источника оплаты Binding: Core ValueSet Источники оплаты (required)
beneficiary		1..1	Reference(Core Patient (Пациент))	Бенефициар
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.identifier:omsPolicy.type.coding:omsType.code	required	Core_Vs_Nsi_Coverage_Document_OMS(a valid code from Core CodeSystem Типы полисов ОМС) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document-oms From this IG
Coverage.type	required	Core_Vs_Nsi_Sources_Of_Payment(a valid code from Core CodeSystem Источники финансирования) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-sources-of-payment From this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
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: AllLanguages (required): IETF language tag for a human language Additional Bindings Purpose CommonLanguages Starter
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
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	Σ	0..*	Identifier	Business identifier(s) for this coverage Slice: Unordered, Open by value:system
identifier:omsPolicy	Σ	0..1	Identifier	Документ, подтверждающий страховку по ОМС
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): Identifies the purpose for this identifier, if known .
type	Σ	1..1	CodeableConcept	Description of identifier Binding: IdentifierTypeCodes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	2..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:hl7Type	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
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: http://terminology.hl7.org/CodeSystem/v2-0203
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: SB
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
coding:omsType	Σ	1..1	Coding	Тип полиса ОМС по справочнику НСИ МЗ РФ
id		0..1	id	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Required Pattern: urn:oid:1.2.643.5.1.13.13.99.2.245
version	Σ	0..1	string	Version of the system - if relevant
code	ΣC	1..1	code	Symbol in syntax defined by the system Binding: Core ValueSet Типы полисов ОМС (required)
display	ΣC	0..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	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/ig/core/systems/oms
value	ΣC	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.
kind	Σ	1..1	code	insurance | self-pay | other Binding: Kind (required)
paymentBy		0..*	BackboneElement	Self-pay parties and responsibility
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
party	Σ	1..1	Reference(Patient | RelatedPerson | Organization)	Parties performing self-payment
responsibility	Σ	0..1	string	Party's responsibility
type	Σ	0..1	CodeableConcept	Тип источника оплаты Binding: Core ValueSet Источники оплаты (required)
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..*	Identifier	ID assigned to the subscriber
beneficiary	Σ	1..1	Reference(Core Patient (Пациент))	Бенефициар
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
insurer	Σ	0..1	Reference(Organization)	Issuer of the policy
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, e.g. Group, Plan, Class, etc.
value	Σ	1..1	Identifier	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.
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example)
network		0..1	CodeableConcept	In or out of network Binding: NetworkTypeCodes (example)
unit		0..1	CodeableConcept	Individual or family Binding: UnitTypeCodes (example)
term		0..1	CodeableConcept	Annual or lifetime Binding: BenefitTermCodes (example)
value[x]	Σ	0..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
insurancePlan		0..1	Reference(InsurancePlan)	Insurance plan details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.language	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages|5.0.0 From the FHIR Standard
Coverage.identifier:omsPolicy.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 From the FHIR Standard
Coverage.identifier:omsPolicy.type	extensible	IdentifierTypeCodes http://hl7.org/fhir/ValueSet/identifier-type From the FHIR Standard
Coverage.identifier:omsPolicy.type.coding:omsType.code	required	Core_Vs_Nsi_Coverage_Document_OMS(a valid code from Core CodeSystem Типы полисов ОМС) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-coverage-document-oms From this IG
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|5.0.0 From the FHIR Standard
Coverage.kind	required	Kind http://hl7.org/fhir/ValueSet/coverage-kind|5.0.0 From the FHIR Standard
Coverage.type	required	Core_Vs_Nsi_Sources_Of_Payment(a valid code from Core CodeSystem Источники финансирования) https://fhir.ru/ig/core/ValueSet/core-vs-nsi-sources-of-payment From this IG
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.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory From the FHIR Standard
Coverage.costToBeneficiary.network	example	NetworkTypeCodes http://hl7.org/fhir/ValueSet/benefit-network From the FHIR Standard
Coverage.costToBeneficiary.unit	example	UnitTypeCodes http://hl7.org/fhir/ValueSet/benefit-unit From the FHIR Standard
Coverage.costToBeneficiary.term	example	BenefitTermCodes http://hl7.org/fhir/ValueSet/benefit-term 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 in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(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

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)

Slices

This structure defines the following Slices:

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