HL7 FHIR Implementation Guide Dossier Farmaceutico, published by HL7 Italia. This guide is not an authorized publication; it is the continuous build for version 0.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-it/dossier-pharma/ and changes regularly. See the Directory of published versions

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Resource Profile: Coverage - Dossier Farmaceutico

Rappresentazionedelle esenzioni attraverso il profilo Coverage

Usage:

• Refer to this Resource Profile: MedicationRequest - Dossier Farmaceutico
• Examples for this Resource Profile: Coverage/161a49c3-693e-49b5-8fd2-b8f78cb3d369

Formal Views of Profile Content

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

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

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage			Coverage
beneficiary	S	1..1	Reference(Patient)	Plan beneficiary
costToBeneficiary
value[x]
Slices for extension				Content/Rules for all slices
data-absent-reason	S	0..1	code	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
exception	S	0..*	BackboneElement	Exceptions for patient payments
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
stato-esenzione	S	0..1	CodeableConcept	Stato esenzione URL: http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus Binding: Stato Esenzione (required)
type	S	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	S	0..1	Period	The effective period of the exception
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.costToBeneficiary.exception.type	extensible	VsMinisteroSaluteEsenzioni https://www.hl7.it/fhir/terminology/ValueSet/vs-mds-esenzioni

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
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
beneficiary	SΣ	1..1	Reference(Patient)	Plan beneficiary
payor	Σ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
value[x]All Types				Content/Rules for all Types
Slices for extension				Content/Rules for all slices
data-absent-reason	S	0..1	code	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception	S	0..*	BackboneElement	Exceptions for patient payments
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
stato-esenzione	S	0..1	CodeableConcept	Stato esenzione URL: http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus Binding: Stato Esenzione (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	SΣ	0..1	Period	The effective period of the exception
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.costToBeneficiary.exception.type	extensible	VsMinisteroSaluteEsenzioni https://www.hl7.it/fhir/terminology/ValueSet/vs-mds-esenzioni

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): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
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	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(Patient)	Plan beneficiary
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(Organization | Patient | RelatedPerson)	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, 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
value[x]All Types				Content/Rules for all Types
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
data-absent-reason	S	0..1	code	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception	S	0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
stato-esenzione	S	0..1	CodeableConcept	Stato esenzione URL: http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus Binding: Stato Esenzione (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	SΣ	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	URI
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 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	extensible	VsMinisteroSaluteEsenzioni https://www.hl7.it/fhir/terminology/ValueSet/vs-mds-esenzioni

This structure is derived from Coverage

Summary

Must-Support: 6 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/data-absent-reason
• http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage			Coverage
beneficiary	S	1..1	Reference(Patient)	Plan beneficiary
costToBeneficiary
value[x]
Slices for extension				Content/Rules for all slices
data-absent-reason	S	0..1	code	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
exception	S	0..*	BackboneElement	Exceptions for patient payments
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
stato-esenzione	S	0..1	CodeableConcept	Stato esenzione URL: http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus Binding: Stato Esenzione (required)
type	S	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	S	0..1	Period	The effective period of the exception
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Coverage.costToBeneficiary.exception.type	extensible	VsMinisteroSaluteEsenzioni https://www.hl7.it/fhir/terminology/ValueSet/vs-mds-esenzioni

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
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
beneficiary	SΣ	1..1	Reference(Patient)	Plan beneficiary
payor	Σ	1..*	Reference(Organization | Patient | RelatedPerson)	Issuer of the policy
costToBeneficiary		0..*	BackboneElement	Patient payments for services/products
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	Σ	1..1		The amount or percentage due from the beneficiary
value[x]All Types				Content/Rules for all Types
Slices for extension				Content/Rules for all slices
data-absent-reason	S	0..1	code	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception	S	0..*	BackboneElement	Exceptions for patient payments
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
stato-esenzione	S	0..1	CodeableConcept	Stato esenzione URL: http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus Binding: Stato Esenzione (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	SΣ	0..1	Period	The effective period of the exception
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
Coverage.costToBeneficiary.exception.type	extensible	VsMinisteroSaluteEsenzioni https://www.hl7.it/fhir/terminology/ValueSet/vs-mds-esenzioni

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): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..*	Identifier	Business Identifier for the coverage
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	Coverage category such as medical or accident Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
policyHolder	Σ	0..1	Reference(Patient | RelatedPerson | Organization)	Owner of the policy
subscriber	Σ	0..1	Reference(Patient | RelatedPerson)	Subscriber to the policy
subscriberId	Σ	0..1	string	ID assigned to the subscriber
beneficiary	SΣ	1..1	Reference(Patient)	Plan beneficiary
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(Organization | Patient | RelatedPerson)	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, 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
value[x]All Types				Content/Rules for all Types
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
data-absent-reason	S	0..1	code	unknown | asked | temp | notasked | masked | unsupported | astext | error URL: http://hl7.org/fhir/StructureDefinition/data-absent-reason Binding: DataAbsentReason (required)
valueQuantity			Quantity(SimpleQuantity)
valueMoney			Money
exception	S	0..*	BackboneElement	Exceptions for patient payments
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
stato-esenzione	S	0..1	CodeableConcept	Stato esenzione URL: http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus Binding: Stato Esenzione (required)
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
type	SΣ	1..1	CodeableConcept	codice esensione Binding: Ministero della Salute - Esenzioni (extensible)
period	SΣ	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	URI
Coverage.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Coverage.status	required	FinancialResourceStatusCodes http://hl7.org/fhir/ValueSet/fm-status|4.0.1 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	extensible	VsMinisteroSaluteEsenzioni https://www.hl7.it/fhir/terminology/ValueSet/vs-mds-esenzioni

This structure is derived from Coverage

Summary

Must-Support: 6 elements

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/StructureDefinition/data-absent-reason
• http://hl7.it/fhir/dossier-pharma/StructureDefinition/coverage-exceptionStatus

Other representations of profile: CSV, Excel, Schematron