0.2.0 - ci-build

RuCoreIG, published by HL7 FHIR Россия. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/fhir-ru/RuCoreIG/ and changes regularly. See the Directory of published versions

Resource Profile: Core Coverage (Страховое покрытие)

Official URL: https://fhir.ru/ig/core/StructureDefinition/core-coverage Version: 0.2.0
Active as of 2025-11-24 Computable Name: Core_Coverage

Базовый профиль страхового покрытия для российских FHIR-реализаций

Core_Coverage — Профиль страхового покрытия

Принятые решения по профилированию

Бизнес-требование Атрибут Решение по профилированию
Необходимо указать тип источника оплаты по НСИ МЗ РФ type Должен быть указан по справочнику НСИ МЗ РФ (ValueSet, CodeSystem).
В случае страховки по ОМС необходимо указать данные полиса identifier[omsPolicy] Определен вариант идентификатора страхового покрытия – Полис ОМС.
В случае страховки ОМС необходимо указывать тип полиса identifier.type.coding[omsType] Определен вариант кодирования типа идентификатора – omsType. Заполняется типом полисов ОМС по справочнику НСИ МЗ РФ (ValueSet, CodeSystem).
Необходимо корректно вести связанную информацию beneficiary Должен быть представлен профилем Core_Patient

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

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)

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 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
.... 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier:omsPolicy.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type.coding:omsType.​code Base required Core ValueSet Типы полисов ОМС 📦0.2.0 This IG
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 FHIR Std.
Coverage.type Base required Core ValueSet Источники оплаты 📦0.2.0 This IG

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().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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.identifier:omsPolicy.​type.coding:omsType.​code Base required Core ValueSet Типы полисов ОМС 📦0.2.0 This IG
Coverage.type Base required Core ValueSet Источники оплаты 📦0.2.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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 BindingsPurpose
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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base required All Languages 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type.coding:omsType.​code Base required Core ValueSet Типы полисов ОМС 📦0.2.0 This IG
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 FHIR Std.
Coverage.type Base required Core ValueSet Источники оплаты 📦0.2.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍5.0.0 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​network Base example Network Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​unit Base example Unit Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​term Base example Benefit Term Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍5.0.0 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().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:

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

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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
.... 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier:omsPolicy.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type.coding:omsType.​code Base required Core ValueSet Типы полисов ОМС 📦0.2.0 This IG
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 FHIR Std.
Coverage.type Base required Core ValueSet Источники оплаты 📦0.2.0 This IG

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().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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Coverage.identifier:omsPolicy.​type.coding:omsType.​code Base required Core ValueSet Типы полисов ОМС 📦0.2.0 This IG
Coverage.type Base required Core ValueSet Источники оплаты 📦0.2.0 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. 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 BindingsPurpose
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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base required All Languages 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​use Base required IdentifierUse 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type Base extensible Identifier Type Codes 📍5.0.0 FHIR Std.
Coverage.identifier:omsPolicy.​type.coding:omsType.​code Base required Core ValueSet Типы полисов ОМС 📦0.2.0 This IG
Coverage.status Base required Financial Resource Status Codes 📍5.0.0 FHIR Std.
Coverage.kind Base required Kind 📍5.0.0 FHIR Std.
Coverage.type Base required Core ValueSet Источники оплаты 📦0.2.0 This IG
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍5.0.0 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​category Base example Benefit Category Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​network Base example Network Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​unit Base example Unit Type Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​term Base example Benefit Term Codes 📍5.0.0 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍5.0.0 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().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:

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

 

Other representations of profile: CSV, Excel, Schematron