HL7 PT FHIR Implementation Guide: Example IG Release 1 | STU1
1.0.0 - STU1

HL7 PT FHIR Implementation Guide: Example IG Release 1 | STU1, publicado por HL7 Portugal. Este guia não é uma publicação autorizada; é a compilação contínua para a versão 1.0.0 construída pela FHIR (HL7® FHIR® Standard) CI Build. Esta versão é baseada no conteúdo atual de https://github.com/hl7-pt/patient-admin-ig/ e muda regularmente. Veja o Diretório de versões publicadas

## Resource Profile: PTCoverage

Official URL: http://example.com/fhir/hl7pt/StructureDefinition/Coverage-Pt | Version: 1.0.0
Active as of 2026-02-13 | Computable Name: PTCoverage

Perfil de Coverage para contexto PT, com tipos de coberturas/isenções, beneficiários (numero de beneficiários, apólices) e entidades responsáveis associadas.

Usos:

- Este Perfil não é utilizado por nenhum perfil neste guia de implementação

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.

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

Nome | Bandeiras | Card. | Tipo | Descrição e condicionalismos Filter: Condicionantes Obrigações Vínculos
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
id | Σ | 1..1 | id | Logical id of this artifact
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Fatias para extension |  | 0..* | Extension | Extension Fatia: Não ordenado, Aberto por value:url
extension:coverage-reason | S | 0..1 | CodeableConcept | motivo de isenção URL: http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Vínculo: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
beneficiary | S Σ | 1..1 | Reference(Patient) | Plan beneficiary
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..1 | Reference(Organization) | Issuer of the policy
Documentação para este formato

#### Terminologia Ligações

Caminho | Estado | Utilização | Conjunto de valores | Versão | Fonte
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | a norma FHIR
Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | a norma FHIR

#### Restrições

Id | Grau | Caminho(s) | Descrição | Expressão
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Coverage

Nome | Bandeiras | Card. | Tipo | Descrição e condicionalismos Filter: Condicionantes Obrigações Vínculos
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
id |  | 1..1 | id | Logical id of this artifact
Fatias para extension |  | 0..* | Extension | Extension Fatia: Não ordenado, Aberto por value:url
extension:coverage-reason | S | 0..1 | CodeableConcept | motivo de isenção URL: http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt
type | S | 0..1 | CodeableConcept | Coverage category such as medical or accident
beneficiary | S | 1..1 | Reference(Patient) | Plan beneficiary
period | S | 0..1 | Period | Coverage start and end dates
payor | S | 1..1 | Reference(Organization) | Issuer of the policy
Documentação para este formato

Nome | Bandeiras | Card. | Tipo | Descrição e condicionalismos Filter: Condicionantes Obrigações Vínculos
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
id | Σ | 1..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 Vínculo: CommonLanguages (preferred): A human language.
Vínculos adicionais | Objetivo
AllLanguages | Vínculo máximo
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
Fatias para extension |  | 0..* | Extension | Extension Fatia: Não ordenado, Aberto por value:url
extension:coverage-reason | S | 0..1 | CodeableConcept | motivo de isenção URL: http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt
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 Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Vínculo: 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 | S Σ | 1..1 | Reference(Patient) | Plan beneficiary
dependent | Σ | 0..1 | string | Dependent number
relationship |  | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Vínculo: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..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' Vínculo: 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 Vínculo: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x] | Σ | 1..1 |  | The amount or percentage due from the beneficiary
valueQuantity |  |  | Quantity(SimpleQuantity) |
valueMoney |  |  | Money |
exception |  | 0..* | BackboneElement | Exceptions for patient payments
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | Σ | 1..1 | CodeableConcept | Exception category Vínculo: 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
Documentação para este formato

#### Terminologia Ligações

Caminho | Estado | Utilização | Conjunto de valores | Versão | Fonte
Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | a norma FHIR
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | a norma FHIR
Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | a norma FHIR
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | a norma FHIR
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | a norma FHIR
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | a norma FHIR
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | a norma FHIR

#### Restrições

Id | Grau | Caminho(s) | Descrição | Expressão
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Coverage

Resumo

Obrigatório: 1 elemento
Deve ser suportado: 5 elementos

Extensões

Esta estrutura refere-se a estas extensões:

- http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt

Key Elements View

Nome | Bandeiras | Card. | Tipo | Descrição e condicionalismos Filter: Condicionantes Obrigações Vínculos
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
id | Σ | 1..1 | id | Logical id of this artifact
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
Fatias para extension |  | 0..* | Extension | Extension Fatia: Não ordenado, Aberto por value:url
extension:coverage-reason | S | 0..1 | CodeableConcept | motivo de isenção URL: http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Vínculo: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
beneficiary | S Σ | 1..1 | Reference(Patient) | Plan beneficiary
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..1 | Reference(Organization) | Issuer of the policy
Documentação para este formato

#### Terminologia Ligações

Caminho | Estado | Utilização | Conjunto de valores | Versão | Fonte
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | a norma FHIR
Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | a norma FHIR

#### Restrições

Id | Grau | Caminho(s) | Descrição | Expressão
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Differential View

This structure is derived from Coverage

Nome | Bandeiras | Card. | Tipo | Descrição e condicionalismos Filter: Condicionantes Obrigações Vínculos
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
id |  | 1..1 | id | Logical id of this artifact
Fatias para extension |  | 0..* | Extension | Extension Fatia: Não ordenado, Aberto por value:url
extension:coverage-reason | S | 0..1 | CodeableConcept | motivo de isenção URL: http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt
type | S | 0..1 | CodeableConcept | Coverage category such as medical or accident
beneficiary | S | 1..1 | Reference(Patient) | Plan beneficiary
period | S | 0..1 | Period | Coverage start and end dates
payor | S | 1..1 | Reference(Organization) | Issuer of the policy
Documentação para este formato

Snapshot View

Nome | Bandeiras | Card. | Tipo | Descrição e condicionalismos Filter: Condicionantes Obrigações Vínculos
--- | --- | --- | --- | ---
Coverage |  | 0..* | Coverage | Insurance or medical plan or a payment agreement
id | Σ | 1..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 Vínculo: CommonLanguages (preferred): A human language.
Vínculos adicionais | Objetivo
AllLanguages | Vínculo máximo
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
Fatias para extension |  | 0..* | Extension | Extension Fatia: Não ordenado, Aberto por value:url
extension:coverage-reason | S | 0..1 | CodeableConcept | motivo de isenção URL: http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt
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 Vínculo: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
type | S Σ | 0..1 | CodeableConcept | Coverage category such as medical or accident Vínculo: 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 | S Σ | 1..1 | Reference(Patient) | Plan beneficiary
dependent | Σ | 0..1 | string | Dependent number
relationship |  | 0..1 | CodeableConcept | Beneficiary relationship to the subscriber Vínculo: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
period | S Σ | 0..1 | Period | Coverage start and end dates
payor | S Σ | 1..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' Vínculo: 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 Vínculo: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
value[x] | Σ | 1..1 |  | The amount or percentage due from the beneficiary
valueQuantity |  |  | Quantity(SimpleQuantity) |
valueMoney |  |  | Money |
exception |  | 0..* | BackboneElement | Exceptions for patient payments
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
type | Σ | 1..1 | CodeableConcept | Exception category Vínculo: 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
Documentação para este formato

#### Terminologia Ligações

Caminho | Estado | Utilização | Conjunto de valores | Versão | Fonte
Coverage.language | Base | preferred | Common Languages | 📍4.0.1 | a norma FHIR
Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | a norma FHIR
Coverage.type | Base | preferred | Coverage Type and Self-Pay Codes | 📍4.0.1 | a norma FHIR
Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📍4.0.1 | a norma FHIR
Coverage.class.type | Base | extensible | Coverage Class Codes | 📍4.0.1 | a norma FHIR
Coverage.costToBeneficiary.​type | Base | extensible | Coverage Copay Type Codes | 📍4.0.1 | a norma FHIR
Coverage.costToBeneficiary.​exception.type | Base | example | Example Coverage Financial Exception Codes | 📍4.0.1 | a norma FHIR

#### Restrições

Id | Grau | Caminho(s) | Descrição | Expressão
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Coverage | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource | `contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`
dom-4 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Coverage | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Coverage

Resumo

Obrigatório: 1 elemento
Deve ser suportado: 5 elementos

Extensões

Esta estrutura refere-se a estas extensões:

- http://example.com/fhir/hl7pt/StructureDefinition/coverage-reason-pt

Other representations of profile: CSV, Excel, Schematron