臺灣社政領域基礎實作指引
0.0.1 - ci-build

臺灣社政領域基礎實作指引, published by 衛生福利部社會及家庭署. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/sfaassn2025-source/base/ and changes regularly. See the Directory of published versions

Resource Profile: 補助資格或補助案件-Coverage TWSS Base

Official URL: https://sfaa.gov.tw/base/StructureDefinition/Coverage-twss-base Version: 0.0.1
Draft as of 2026-10-21 Computable Name: CoverageTWSSBase

補助資格或補助案件-Coverage TWSS Base Profile 表達衛生福利部社會及家庭署業務中的補助或給付資格。本 Profile 因社福補助語境與 TWSS Base 的 reference target 需求與 TW Core Coverage 0.3.2 限制不同，故繼承原生 Coverage，並沿用相容的 TW Core 0.3.2 規則。

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: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:aidYear This element must be supported. 0..1 integer 補助年度
URL: https://sfaa.gov.tw/base/StructureDefinition/twss-coverage-aid-year
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element must be supported. This element is included in summaries. 0..1 CodeableConceptTW 補助資格或給付資格類型。
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.
Coverage.policyHolder This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Owner of the policy
Coverage.subscriber This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Subscriber to the policy
Coverage.subscriberId This element must be supported. This element is included in summaries. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) Plan beneficiary
Coverage.relationship This element must be supported. 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element must be supported. This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element must be supported. This element is included in summaries. 1..* Reference(機構資料-Organization TWSS Base | 個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Issuer of the policy
Coverage.class This element must be supported. 0..* BackboneElement Additional coverage classifications
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.costToBeneficiary This element must be supported. 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 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().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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:aidYear This element must be supported. 0..1 integer 補助年度
URL: https://sfaa.gov.tw/base/StructureDefinition/twss-coverage-aid-year
Coverage.identifier This element must be supported. 0..* Identifier Business Identifier for the coverage
Coverage.status This element must be supported. 1..1 code active | cancelled | draft | entered-in-error
Coverage.policyHolder This element must be supported. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Owner of the policy
Coverage.subscriber This element must be supported. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Subscriber to the policy
Coverage.subscriberId This element must be supported. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element must be supported. 1..1 Reference(個案資料-Patient TWSS Base) Plan beneficiary
Coverage.relationship This element must be supported. 0..1 CodeableConcept Beneficiary relationship to the subscriber
Coverage.period This element must be supported. 0..1 Period Coverage start and end dates
Coverage.payor This element must be supported. 1..* Reference(機構資料-Organization TWSS Base | 個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Issuer of the policy
Coverage.class This element must be supported. 0..* BackboneElement Additional coverage classifications
Coverage.costToBeneficiary This element must be supported. 0..* BackboneElement Patient payments for services/products

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element is included in summaries. 0..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Coverage.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
Coverage.contained 0..* Resource Contained, inline Resources
Coverage.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:aidYear This element must be supported. 0..1 integer 補助年度
URL: https://sfaa.gov.tw/base/StructureDefinition/twss-coverage-aid-year
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element must be supported. This element is included in summaries. 0..1 CodeableConceptTW 補助資格或給付資格類型。
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.
Coverage.policyHolder This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Owner of the policy
Coverage.subscriber This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Subscriber to the policy
Coverage.subscriberId This element must be supported. This element is included in summaries. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) Plan beneficiary
Coverage.dependent This element is included in summaries. 0..1 string Dependent number
Coverage.relationship This element must be supported. 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element must be supported. This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element must be supported. This element is included in summaries. 1..* Reference(機構資料-Organization TWSS Base | 個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Issuer of the policy
Coverage.class This element must be supported. 0..* BackboneElement Additional coverage classifications
Coverage.class.id 0..1 string Unique id for inter-element referencing
Coverage.class.extension 0..* Extension Additional content defined by implementations
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.class.name This element is included in summaries. 0..1 string Human readable description of the type and value
Coverage.order This element is included in summaries. 0..1 positiveInt Relative order of the coverage
Coverage.network This element is included in summaries. 0..1 string Insurer network
Coverage.costToBeneficiary This element must be supported. 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money
Coverage.costToBeneficiary.exception 0..* BackboneElement Exceptions for patient payments
Coverage.costToBeneficiary.exception.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type This element is included in summaries. 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period This element is included in summaries. 0..1 Period The effective period of the exception
Coverage.subrogation 0..1 boolean Reimbursement to insurer
Coverage.contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 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().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()

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:aidYear This element must be supported. 0..1 integer 補助年度
URL: https://sfaa.gov.tw/base/StructureDefinition/twss-coverage-aid-year
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element must be supported. This element is included in summaries. 0..1 CodeableConceptTW 補助資格或給付資格類型。
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.
Coverage.policyHolder This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Owner of the policy
Coverage.subscriber This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Subscriber to the policy
Coverage.subscriberId This element must be supported. This element is included in summaries. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) Plan beneficiary
Coverage.relationship This element must be supported. 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element must be supported. This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element must be supported. This element is included in summaries. 1..* Reference(機構資料-Organization TWSS Base | 個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Issuer of the policy
Coverage.class This element must be supported. 0..* BackboneElement Additional coverage classifications
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.costToBeneficiary This element must be supported. 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 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().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

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:aidYear This element must be supported. 0..1 integer 補助年度
URL: https://sfaa.gov.tw/base/StructureDefinition/twss-coverage-aid-year
Coverage.identifier This element must be supported. 0..* Identifier Business Identifier for the coverage
Coverage.status This element must be supported. 1..1 code active | cancelled | draft | entered-in-error
Coverage.type This element must be supported. 0..1 CodeableConceptTW 補助資格或給付資格類型。
Coverage.policyHolder This element must be supported. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Owner of the policy
Coverage.subscriber This element must be supported. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Subscriber to the policy
Coverage.subscriberId This element must be supported. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element must be supported. 1..1 Reference(個案資料-Patient TWSS Base) Plan beneficiary
Coverage.relationship This element must be supported. 0..1 CodeableConcept Beneficiary relationship to the subscriber
Coverage.period This element must be supported. 0..1 Period Coverage start and end dates
Coverage.payor This element must be supported. 1..* Reference(機構資料-Organization TWSS Base | 個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Issuer of the policy
Coverage.class This element must be supported. 0..* BackboneElement Additional coverage classifications
Coverage.costToBeneficiary This element must be supported. 0..* BackboneElement Patient payments for services/products

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Coverage 0..* Coverage Insurance or medical plan or a payment agreement
Coverage.id This element is included in summaries. 0..1 id Logical id of this artifact
Coverage.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Coverage.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Coverage.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Coverage.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
Coverage.contained 0..* Resource Contained, inline Resources
Coverage.Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url

Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Coverage.Slices for extension.extension:aidYear This element must be supported. 0..1 integer 補助年度
URL: https://sfaa.gov.tw/base/StructureDefinition/twss-coverage-aid-year
Coverage.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Coverage.identifier This element must be supported. This element is included in summaries. 0..* Identifier Business Identifier for the coverage
Coverage.status This element is a modifier element. This element must be supported. This element is included in summaries. 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Coverage.type This element must be supported. This element is included in summaries. 0..1 CodeableConceptTW 補助資格或給付資格類型。
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.
Coverage.policyHolder This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base | 機構資料-Organization TWSS Base) Owner of the policy
Coverage.subscriber This element must be supported. This element is included in summaries. 0..1 Reference(個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Subscriber to the policy
Coverage.subscriberId This element must be supported. This element is included in summaries. 0..1 string ID assigned to the subscriber
Coverage.beneficiary This element must be supported. This element is included in summaries. 1..1 Reference(個案資料-Patient TWSS Base) Plan beneficiary
Coverage.dependent This element is included in summaries. 0..1 string Dependent number
Coverage.relationship This element must be supported. 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
Coverage.period This element must be supported. This element is included in summaries. 0..1 Period Coverage start and end dates
Coverage.payor This element must be supported. This element is included in summaries. 1..* Reference(機構資料-Organization TWSS Base | 個案資料-Patient TWSS Base | 關係人資料-RelatedPerson TWSS Base) Issuer of the policy
Coverage.class This element must be supported. 0..* BackboneElement Additional coverage classifications
Coverage.class.id 0..1 string Unique id for inter-element referencing
Coverage.class.extension 0..* Extension Additional content defined by implementations
Coverage.class.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.class.type This element is included in summaries. 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
Coverage.class.value This element is included in summaries. 1..1 string Value associated with the type
Coverage.class.name This element is included in summaries. 0..1 string Human readable description of the type and value
Coverage.order This element is included in summaries. 0..1 positiveInt Relative order of the coverage
Coverage.network This element is included in summaries. 0..1 string Insurer network
Coverage.costToBeneficiary This element must be supported. 0..* BackboneElement Patient payments for services/products
Coverage.costToBeneficiary.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.type This element is included in summaries. 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
Coverage.costToBeneficiary.value[x] This element is included in summaries. 1..1 The amount or percentage due from the beneficiary
Coverage.costToBeneficiary.value[x].valueQuantity Quantity(SimpleQuantity)
Coverage.costToBeneficiary.value[x].valueMoney Money
Coverage.costToBeneficiary.exception 0..* BackboneElement Exceptions for patient payments
Coverage.costToBeneficiary.exception.id 0..1 string Unique id for inter-element referencing
Coverage.costToBeneficiary.exception.extension 0..* Extension Additional content defined by implementations
Coverage.costToBeneficiary.exception.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Coverage.costToBeneficiary.exception.type This element is included in summaries. 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
Coverage.costToBeneficiary.exception.period This element is included in summaries. 0..1 Period The effective period of the exception
Coverage.subrogation 0..1 boolean Reimbursement to insurer
Coverage.contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base preferred Coverage Type and Self-Pay Codes 📍4.0.1 FHIR Std.
Coverage.relationship Base extensible SubscriberPolicyholder Relationship Codes 📍4.0.1 FHIR Std.
Coverage.class.type Base extensible Coverage Class Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​type Base extensible Coverage Copay Type Codes 📍4.0.1 FHIR Std.
Coverage.costToBeneficiary.​exception.type Base example Example Coverage Financial Exception Codes 📍4.0.1 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().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()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

建議應該支援以下查詢參數：

此 Profile 使用 FHIR R4 Coverage Resource；伺服端建議（SHOULD）支援以下 FHIR 原生查詢參數： 完整定義請參考 FHIR R4 Coverage 原生查詢參數。

查詢參數 類型 查詢範例
_content string GET [base]/_content=[value]
_filter special GET [base]/_filter=[value]
_id token GET [base]/Coverage/[id]
_lastUpdated date GET [base]/_lastUpdated=[value]
_profile uri GET [base]/_profile=[value]
_query token GET [base]/_query=[value]
_security token GET [base]/_security=[value]
_source uri GET [base]/_source=[value]
_tag token GET [base]/_tag=[value]
_text string GET [base]/_text=[value]
beneficiary reference GET [base]/beneficiary=[value]
class-type token GET [base]/class-type=[value]
class-value string GET [base]/class-value=[value]
dependent string GET [base]/dependent=[value]
identifier token GET [base]/identifier=[value]
patient reference GET [base]/patient=[value]
payor reference GET [base]/payor=[value]
policy-holder reference GET [base]/policy-holder=[value]
status token GET [base]/status=[value]
subscriber reference GET [base]/subscriber=[value]
type token GET [base]/type=[value]