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13.1 Ресурс Coverage - Назначение

Financial Management Work GroupMaturity Level: 2 Trial UseCompartments: Patient, RelatedPerson

Финансовый инструмент, который может быть использован для оплаты или компенсации за продукты и услуги в области здравоохранения.

Ресурс Coverage предназначен для предоставления идентификаторов высокого уровня и, потенциально, дескрипторов страхового плана, которые могут использоваться для оплаты, частично или целиком, предоставления товаров и услуг здравоохранения.

Этот ресурс также можно использовать для фиксирования случая 'SelfPay' - самооплата, где лицо или организация, отличные от страховой компании, берут на себя ответственность за оплату части затрат на здравоохранение.

На этот ресурс ссылаются Account, Claim, ClaimResponse, EligibilityRequest, EligibilityResponse, EnrollmentRequest, ExplanationOfBenefit, MedicationRequest и ServiceRequest

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. Coverage DomainResourceInsurance or medical plan or a payment agreement
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierОсновной идентификатор страхового покрытия
... status ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... type Σ0..1CodeableConceptType of coverage such as medical or accident
Coverage Type and Self-Pay Codes (Preferred)
... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber Σ0..1Reference(Patient | RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the Subscriber
... beneficiary Σ0..1Reference(Patient)Выгодоприобретатель плана
... relationship 0..1CodeableConceptBeneficiary relationship to the Subscriber
Policyholder Relationship Codes (Example)
... period Σ0..1PeriodДата начала и окончания действия страхового покрытия
... payor Σ0..*Reference(Organization | Patient | RelatedPerson)Identifier for the plan or agreement issuer
... grouping 0..1BackboneElementAdditional coverage classifications
.... group Σ0..1stringИдентификатор группы
.... groupDisplay Σ0..1stringDisplay text for an identifier for the group
.... subGroup Σ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay Σ0..1stringDisplay text for the subsection of the group
.... plan Σ0..1stringИдентификатор плана (медицинского обслуживания)
.... planDisplay Σ0..1stringDisplay text for the plan
.... subPlan Σ0..1stringИдентификатор подраздела плана (медицинского обслуживания)
.... subPlanDisplay Σ0..1stringDisplay text for the subsection of the plan
.... class Σ0..1stringAn identifier for the class
.... classDisplay Σ0..1stringDisplay text for the class
.... subClass Σ0..1stringAn identifier for the subsection of the class
.... subClassDisplay Σ0..1stringDisplay text for the subsection of the subclass
... dependent Σ0..1stringНомер материально зависимого лица
... sequence Σ0..1stringСчетчик экземпляра плана или последовательности
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringСеть страховых компаний
... contract 0..*Reference(Contract)Детали контракта

doco Документация по этому формату

UML-диаграмма (Legend)

Coverage (DomainResource)The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependantidentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [0..1] « A code specifying the state of the resource instance. (Strength=Required)Financial Resource Status ! »The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organizationtype : CodeableConcept [0..1] « The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. (Strength=Preferred)Coverage Type and Self-Pay ? »The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employerpolicyHolder : Reference [0..1] « Patient|RelatedPerson|Organization »The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is duesubscriber : Reference [0..1] « Patient|RelatedPerson »The insurer assigned ID for the SubscribersubscriberId : string [0..1]The party who benefits from the insurance coverage., the patient when services are providedbeneficiary : Reference [0..1] « Patient »The relationship of beneficiary (patient) to the subscriberrelationship : CodeableConcept [0..1] « The relationship between the Policyholder and the Beneficiary (insured/covered party/patient). (Strength=Example)Policyholder Relationship ?? »Период действия страхового покрытия. Отсутствие даты начала означает, что дата начала действия не известна, отсутствие даты окончания значит, что страховое покрытие продолжает оставаться в силеperiod : Period [0..1]The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number)payor : Reference [0..*] « Organization|Patient|RelatedPerson »Уникальный идентификатор материально зависимого лица страхового покрытияdependent : string [0..1]Дополнительный счетчик для конкретного экземпляра идентифицированного страхового покрытия, который увеличивается при каждом продленииsequence : string [0..1]The order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of careorder : positiveInt [0..1]The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions applynetwork : string [0..1]Страховой полис(-ы), который подтверждает это страховое покрытиеcontract : Reference [0..*] « Contract »GroupИдентифицирует направление или коллектив страхового покрытия, предоставляемого страховщиком, например может использоваться для определения категории страхового покрытия или группы работодателя. Может также упоминаться как номер полиса или группы (Policy ID, Group ID)group : string [0..1]A short description for the groupgroupDisplay : string [0..1]Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a subset of an employer groupsubGroup : string [0..1]A short description for the subgroupsubGroupDisplay : string [0..1]Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division IDplan : string [0..1]A short description for the planplanDisplay : string [0..1]Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employeessubPlan : string [0..1]A short description for the subplansubPlanDisplay : string [0..1]Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage such as a level of deductables or co-paymentclass : string [0..1]A short description for the classclassDisplay : string [0..1]Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a subclass of coverage such as a sub-level of deductables or co-paymentsubClass : string [0..1]A short description for the subclasssubClassDisplay : string [0..1]A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plangrouping[0..1]

XML-шаблон

<Coverage xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Основной идентификатор страхового покрытия --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 0..1 CodeableConcept Type of coverage such as medical or accident --></type>
 <policyHolder><!-- 0..1 Reference(Patient|RelatedPerson|Organization) Owner of the policy --></policyHolder>
 <subscriber><!-- 0..1 Reference(Patient|RelatedPerson) Subscriber to the policy --></subscriber>
 <subscriberId value="[string]"/><!-- 0..1 ID assigned to the Subscriber -->
 <beneficiary><!-- 0..1 Reference(Patient) Выгодоприобретатель плана --></beneficiary>
 <relationship><!-- 0..1 CodeableConcept Beneficiary relationship to the Subscriber --></relationship>
 <period><!-- 0..1 Period Дата начала и окончания действия страхового покрытия --></period>
 <payor><!-- 0..* Reference(Organization|Patient|RelatedPerson) Identifier for the plan or agreement issuer --></payor>
 <grouping>  <!-- 0..1 Additional coverage classifications -->
  <group value="[string]"/><!-- 0..1 Идентификатор группы -->
  <groupDisplay value="[string]"/><!-- 0..1 Display text for an identifier for the group -->
  <subGroup value="[string]"/><!-- 0..1 An identifier for the subsection of the group -->
  <subGroupDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the group -->
  <plan value="[string]"/><!-- 0..1 Идентификатор плана (медицинского обслуживания) -->
  <planDisplay value="[string]"/><!-- 0..1 Display text for the plan -->
  <subPlan value="[string]"/><!-- 0..1 Идентификатор подраздела плана  (медицинского обслуживания) -->
  <subPlanDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the plan -->
  <class value="[string]"/><!-- 0..1 An identifier for the class -->
  <classDisplay value="[string]"/><!-- 0..1 Display text for the class -->
  <subClass value="[string]"/><!-- 0..1 An identifier for the subsection of the class -->
  <subClassDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the subclass -->
 </grouping>
 <dependent value="[string]"/><!-- 0..1 Номер материально зависимого лица -->
 <sequence value="[string]"/><!-- 0..1 Счетчик экземпляра плана или последовательности -->
 <order value="[positiveInt]"/><!-- 0..1 Relative order of the coverage -->
 <network value="[string]"/><!-- 0..1 Сеть страховых компаний -->
 <contract><!-- 0..* Reference(Contract) Детали контракта --></contract>
</Coverage>

JSON-шаблон

{doco
  "resourceType" : "Coverage",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Основной идентификатор страхового покрытия
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // Type of coverage such as medical or accident
  "policyHolder" : { Reference(Patient|RelatedPerson|Organization) }, // Owner of the policy
  "subscriber" : { Reference(Patient|RelatedPerson) }, // Subscriber to the policy
  "subscriberId" : "<string>", // ID assigned to the Subscriber
  "beneficiary" : { Reference(Patient) }, // Выгодоприобретатель плана
  "relationship" : { CodeableConcept }, // Beneficiary relationship to the Subscriber
  "period" : { Period }, // Дата начала и окончания действия страхового покрытия
  "payor" : [{ Reference(Organization|Patient|RelatedPerson) }], // Identifier for the plan or agreement issuer
  "grouping" : { // Additional coverage classifications
    "group" : "<string>", // Идентификатор группы
    "groupDisplay" : "<string>", // Display text for an identifier for the group
    "subGroup" : "<string>", // An identifier for the subsection of the group
    "subGroupDisplay" : "<string>", // Display text for the subsection of the group
    "plan" : "<string>", // Идентификатор плана (медицинского обслуживания)
    "planDisplay" : "<string>", // Display text for the plan
    "subPlan" : "<string>", // Идентификатор подраздела плана  (медицинского обслуживания)
    "subPlanDisplay" : "<string>", // Display text for the subsection of the plan
    "class" : "<string>", // An identifier for the class
    "classDisplay" : "<string>", // Display text for the class
    "subClass" : "<string>", // An identifier for the subsection of the class
    "subClassDisplay" : "<string>" // Display text for the subsection of the subclass
  },
  "dependent" : "<string>", // Номер материально зависимого лица
  "sequence" : "<string>", // Счетчик экземпляра плана или последовательности
  "order" : "<positiveInt>", // Relative order of the coverage
  "network" : "<string>", // Сеть страховых компаний
  "contract" : [{ Reference(Contract) }] // Детали контракта
}

Turtle-шаблон

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Coverage;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Coverage.identifier [ Identifier ], ... ; # 0..* Основной идентификатор страхового покрытия
  fhir:Coverage.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:Coverage.type [ CodeableConcept ]; # 0..1 Type of coverage such as medical or accident
  fhir:Coverage.policyHolder [ Reference(Patient|RelatedPerson|Organization) ]; # 0..1 Owner of the policy
  fhir:Coverage.subscriber [ Reference(Patient|RelatedPerson) ]; # 0..1 Subscriber to the policy
  fhir:Coverage.subscriberId [ string ]; # 0..1 ID assigned to the Subscriber
  fhir:Coverage.beneficiary [ Reference(Patient) ]; # 0..1 Выгодоприобретатель плана
  fhir:Coverage.relationship [ CodeableConcept ]; # 0..1 Beneficiary relationship to the Subscriber
  fhir:Coverage.period [ Period ]; # 0..1 Дата начала и окончания действия страхового покрытия
  fhir:Coverage.payor [ Reference(Organization|Patient|RelatedPerson) ], ... ; # 0..* Identifier for the plan or agreement issuer
  fhir:Coverage.grouping [ # 0..1 Additional coverage classifications
    fhir:Coverage.grouping.group [ string ]; # 0..1 Идентификатор группы
    fhir:Coverage.grouping.groupDisplay [ string ]; # 0..1 Display text for an identifier for the group
    fhir:Coverage.grouping.subGroup [ string ]; # 0..1 An identifier for the subsection of the group
    fhir:Coverage.grouping.subGroupDisplay [ string ]; # 0..1 Display text for the subsection of the group
    fhir:Coverage.grouping.plan [ string ]; # 0..1 Идентификатор плана (медицинского обслуживания)
    fhir:Coverage.grouping.planDisplay [ string ]; # 0..1 Display text for the plan
    fhir:Coverage.grouping.subPlan [ string ]; # 0..1 Идентификатор подраздела плана  (медицинского обслуживания)
    fhir:Coverage.grouping.subPlanDisplay [ string ]; # 0..1 Display text for the subsection of the plan
    fhir:Coverage.grouping.class [ string ]; # 0..1 An identifier for the class
    fhir:Coverage.grouping.classDisplay [ string ]; # 0..1 Display text for the class
    fhir:Coverage.grouping.subClass [ string ]; # 0..1 An identifier for the subsection of the class
    fhir:Coverage.grouping.subClassDisplay [ string ]; # 0..1 Display text for the subsection of the subclass
  ];
  fhir:Coverage.dependent [ string ]; # 0..1 Номер материально зависимого лица
  fhir:Coverage.sequence [ string ]; # 0..1 Счетчик экземпляра плана или последовательности
  fhir:Coverage.order [ positiveInt ]; # 0..1 Relative order of the coverage
  fhir:Coverage.network [ string ]; # 0..1 Сеть страховых компаний
  fhir:Coverage.contract [ Reference(Contract) ], ... ; # 0..* Детали контракта
]

Changes since DSTU2

Coverage
Coverage.status
  • Added Element
Coverage.type
  • Type changed from Coding to CodeableConcept
Coverage.policyHolder
  • Added Element
Coverage.subscriber
  • Add Reference(RelatedPerson)
  • No longer marked as Modifier
Coverage.subscriberId
  • Type changed from Identifier to string
Coverage.beneficiary
  • Added Element
Coverage.relationship
  • Added Element
Coverage.payor
  • Added Element
Coverage.grouping
  • Added Element
Coverage.grouping.group
  • Added Element
Coverage.grouping.groupDisplay
  • Added Element
Coverage.grouping.subGroup
  • Added Element
Coverage.grouping.subGroupDisplay
  • Added Element
Coverage.grouping.plan
  • Added Element
Coverage.grouping.planDisplay
  • Added Element
Coverage.grouping.subPlan
  • Added Element
Coverage.grouping.subPlanDisplay
  • Added Element
Coverage.grouping.class
  • Added Element
Coverage.grouping.classDisplay
  • Added Element
Coverage.grouping.subClass
  • Added Element
Coverage.grouping.subClassDisplay
  • Added Element
Coverage.dependent
  • Type changed from positiveInt to string
Coverage.sequence
  • Type changed from positiveInt to string
Coverage.order
  • Added Element
Coverage.network
  • Type changed from Identifier to string
Coverage.issuer
  • deleted
Coverage.bin
  • deleted
Coverage.group
  • deleted
Coverage.plan
  • deleted
Coverage.subPlan
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

Структура

ИмяФлагиКард.ТипОписание и ограниченияdoco
.. Coverage DomainResourceInsurance or medical plan or a payment agreement
Элементы, определённые в прародителе: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierОсновной идентификатор страхового покрытия
... status ?!Σ0..1codeactive | cancelled | draft | entered-in-error
Financial Resource Status Codes (Required)
... type Σ0..1CodeableConceptType of coverage such as medical or accident
Coverage Type and Self-Pay Codes (Preferred)
... policyHolder Σ0..1Reference(Patient | RelatedPerson | Organization)Owner of the policy
... subscriber Σ0..1Reference(Patient | RelatedPerson)Subscriber to the policy
... subscriberId Σ0..1stringID assigned to the Subscriber
... beneficiary Σ0..1Reference(Patient)Выгодоприобретатель плана
... relationship 0..1CodeableConceptBeneficiary relationship to the Subscriber
Policyholder Relationship Codes (Example)
... period Σ0..1PeriodДата начала и окончания действия страхового покрытия
... payor Σ0..*Reference(Organization | Patient | RelatedPerson)Identifier for the plan or agreement issuer
... grouping 0..1BackboneElementAdditional coverage classifications
.... group Σ0..1stringИдентификатор группы
.... groupDisplay Σ0..1stringDisplay text for an identifier for the group
.... subGroup Σ0..1stringAn identifier for the subsection of the group
.... subGroupDisplay Σ0..1stringDisplay text for the subsection of the group
.... plan Σ0..1stringИдентификатор плана (медицинского обслуживания)
.... planDisplay Σ0..1stringDisplay text for the plan
.... subPlan Σ0..1stringИдентификатор подраздела плана (медицинского обслуживания)
.... subPlanDisplay Σ0..1stringDisplay text for the subsection of the plan
.... class Σ0..1stringAn identifier for the class
.... classDisplay Σ0..1stringDisplay text for the class
.... subClass Σ0..1stringAn identifier for the subsection of the class
.... subClassDisplay Σ0..1stringDisplay text for the subsection of the subclass
... dependent Σ0..1stringНомер материально зависимого лица
... sequence Σ0..1stringСчетчик экземпляра плана или последовательности
... order Σ0..1positiveIntRelative order of the coverage
... network Σ0..1stringСеть страховых компаний
... contract 0..*Reference(Contract)Детали контракта

doco Документация по этому формату

UML-диаграмма (Legend)

Coverage (DomainResource)The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatination of the Coverage.SubscriberID and the Coverage.dependantidentifier : Identifier [0..*]The status of the resource instance (this element modifies the meaning of other elements)status : code [0..1] « A code specifying the state of the resource instance. (Strength=Required)Financial Resource Status ! »The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organizationtype : CodeableConcept [0..1] « The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization. (Strength=Preferred)Coverage Type and Self-Pay ? »The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employerpolicyHolder : Reference [0..1] « Patient|RelatedPerson|Organization »The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is duesubscriber : Reference [0..1] « Patient|RelatedPerson »The insurer assigned ID for the SubscribersubscriberId : string [0..1]The party who benefits from the insurance coverage., the patient when services are providedbeneficiary : Reference [0..1] « Patient »The relationship of beneficiary (patient) to the subscriberrelationship : CodeableConcept [0..1] « The relationship between the Policyholder and the Beneficiary (insured/covered party/patient). (Strength=Example)Policyholder Relationship ?? »Период действия страхового покрытия. Отсутствие даты начала означает, что дата начала действия не известна, отсутствие даты окончания значит, что страховое покрытие продолжает оставаться в силеperiod : Period [0..1]The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements. May provide multiple identifiers such as insurance company identifier or business identifier (BIN number)payor : Reference [0..*] « Organization|Patient|RelatedPerson »Уникальный идентификатор материально зависимого лица страхового покрытияdependent : string [0..1]Дополнительный счетчик для конкретного экземпляра идентифицированного страхового покрытия, который увеличивается при каждом продленииsequence : string [0..1]The order of applicability of this coverage relative to other coverages which are currently inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard etc. as the specific positioning of coverages depends upon the episode of careorder : positiveInt [0..1]The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions applynetwork : string [0..1]Страховой полис(-ы), который подтверждает это страховое покрытиеcontract : Reference [0..*] « Contract »GroupИдентифицирует направление или коллектив страхового покрытия, предоставляемого страховщиком, например может использоваться для определения категории страхового покрытия или группы работодателя. Может также упоминаться как номер полиса или группы (Policy ID, Group ID)group : string [0..1]A short description for the groupgroupDisplay : string [0..1]Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a subset of an employer groupsubGroup : string [0..1]A short description for the subgroupsubGroupDisplay : string [0..1]Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a collection of benefits provided to employees. May be referred to as a Section or Division IDplan : string [0..1]A short description for the planplanDisplay : string [0..1]Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example may be used to identify a subset of a collection of benefits provided to employeessubPlan : string [0..1]A short description for the subplansubPlanDisplay : string [0..1]Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage such as a level of deductables or co-paymentclass : string [0..1]A short description for the classclassDisplay : string [0..1]Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a subclass of coverage such as a sub-level of deductables or co-paymentsubClass : string [0..1]A short description for the subclasssubClassDisplay : string [0..1]A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plangrouping[0..1]

XML-шаблон

<Coverage xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Основной идентификатор страхового покрытия --></identifier>
 <status value="[code]"/><!-- 0..1 active | cancelled | draft | entered-in-error -->
 <type><!-- 0..1 CodeableConcept Type of coverage such as medical or accident --></type>
 <policyHolder><!-- 0..1 Reference(Patient|RelatedPerson|Organization) Owner of the policy --></policyHolder>
 <subscriber><!-- 0..1 Reference(Patient|RelatedPerson) Subscriber to the policy --></subscriber>
 <subscriberId value="[string]"/><!-- 0..1 ID assigned to the Subscriber -->
 <beneficiary><!-- 0..1 Reference(Patient) Выгодоприобретатель плана --></beneficiary>
 <relationship><!-- 0..1 CodeableConcept Beneficiary relationship to the Subscriber --></relationship>
 <period><!-- 0..1 Period Дата начала и окончания действия страхового покрытия --></period>
 <payor><!-- 0..* Reference(Organization|Patient|RelatedPerson) Identifier for the plan or agreement issuer --></payor>
 <grouping>  <!-- 0..1 Additional coverage classifications -->
  <group value="[string]"/><!-- 0..1 Идентификатор группы -->
  <groupDisplay value="[string]"/><!-- 0..1 Display text for an identifier for the group -->
  <subGroup value="[string]"/><!-- 0..1 An identifier for the subsection of the group -->
  <subGroupDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the group -->
  <plan value="[string]"/><!-- 0..1 Идентификатор плана (медицинского обслуживания) -->
  <planDisplay value="[string]"/><!-- 0..1 Display text for the plan -->
  <subPlan value="[string]"/><!-- 0..1 Идентификатор подраздела плана  (медицинского обслуживания) -->
  <subPlanDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the plan -->
  <class value="[string]"/><!-- 0..1 An identifier for the class -->
  <classDisplay value="[string]"/><!-- 0..1 Display text for the class -->
  <subClass value="[string]"/><!-- 0..1 An identifier for the subsection of the class -->
  <subClassDisplay value="[string]"/><!-- 0..1 Display text for the subsection of the subclass -->
 </grouping>
 <dependent value="[string]"/><!-- 0..1 Номер материально зависимого лица -->
 <sequence value="[string]"/><!-- 0..1 Счетчик экземпляра плана или последовательности -->
 <order value="[positiveInt]"/><!-- 0..1 Relative order of the coverage -->
 <network value="[string]"/><!-- 0..1 Сеть страховых компаний -->
 <contract><!-- 0..* Reference(Contract) Детали контракта --></contract>
</Coverage>

JSON-шаблон

{doco
  "resourceType" : "Coverage",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Основной идентификатор страхового покрытия
  "status" : "<code>", // active | cancelled | draft | entered-in-error
  "type" : { CodeableConcept }, // Type of coverage such as medical or accident
  "policyHolder" : { Reference(Patient|RelatedPerson|Organization) }, // Owner of the policy
  "subscriber" : { Reference(Patient|RelatedPerson) }, // Subscriber to the policy
  "subscriberId" : "<string>", // ID assigned to the Subscriber
  "beneficiary" : { Reference(Patient) }, // Выгодоприобретатель плана
  "relationship" : { CodeableConcept }, // Beneficiary relationship to the Subscriber
  "period" : { Period }, // Дата начала и окончания действия страхового покрытия
  "payor" : [{ Reference(Organization|Patient|RelatedPerson) }], // Identifier for the plan or agreement issuer
  "grouping" : { // Additional coverage classifications
    "group" : "<string>", // Идентификатор группы
    "groupDisplay" : "<string>", // Display text for an identifier for the group
    "subGroup" : "<string>", // An identifier for the subsection of the group
    "subGroupDisplay" : "<string>", // Display text for the subsection of the group
    "plan" : "<string>", // Идентификатор плана (медицинского обслуживания)
    "planDisplay" : "<string>", // Display text for the plan
    "subPlan" : "<string>", // Идентификатор подраздела плана  (медицинского обслуживания)
    "subPlanDisplay" : "<string>", // Display text for the subsection of the plan
    "class" : "<string>", // An identifier for the class
    "classDisplay" : "<string>", // Display text for the class
    "subClass" : "<string>", // An identifier for the subsection of the class
    "subClassDisplay" : "<string>" // Display text for the subsection of the subclass
  },
  "dependent" : "<string>", // Номер материально зависимого лица
  "sequence" : "<string>", // Счетчик экземпляра плана или последовательности
  "order" : "<positiveInt>", // Relative order of the coverage
  "network" : "<string>", // Сеть страховых компаний
  "contract" : [{ Reference(Contract) }] // Детали контракта
}

Turtle-шаблон

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:Coverage;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:Coverage.identifier [ Identifier ], ... ; # 0..* Основной идентификатор страхового покрытия
  fhir:Coverage.status [ code ]; # 0..1 active | cancelled | draft | entered-in-error
  fhir:Coverage.type [ CodeableConcept ]; # 0..1 Type of coverage such as medical or accident
  fhir:Coverage.policyHolder [ Reference(Patient|RelatedPerson|Organization) ]; # 0..1 Owner of the policy
  fhir:Coverage.subscriber [ Reference(Patient|RelatedPerson) ]; # 0..1 Subscriber to the policy
  fhir:Coverage.subscriberId [ string ]; # 0..1 ID assigned to the Subscriber
  fhir:Coverage.beneficiary [ Reference(Patient) ]; # 0..1 Выгодоприобретатель плана
  fhir:Coverage.relationship [ CodeableConcept ]; # 0..1 Beneficiary relationship to the Subscriber
  fhir:Coverage.period [ Period ]; # 0..1 Дата начала и окончания действия страхового покрытия
  fhir:Coverage.payor [ Reference(Organization|Patient|RelatedPerson) ], ... ; # 0..* Identifier for the plan or agreement issuer
  fhir:Coverage.grouping [ # 0..1 Additional coverage classifications
    fhir:Coverage.grouping.group [ string ]; # 0..1 Идентификатор группы
    fhir:Coverage.grouping.groupDisplay [ string ]; # 0..1 Display text for an identifier for the group
    fhir:Coverage.grouping.subGroup [ string ]; # 0..1 An identifier for the subsection of the group
    fhir:Coverage.grouping.subGroupDisplay [ string ]; # 0..1 Display text for the subsection of the group
    fhir:Coverage.grouping.plan [ string ]; # 0..1 Идентификатор плана (медицинского обслуживания)
    fhir:Coverage.grouping.planDisplay [ string ]; # 0..1 Display text for the plan
    fhir:Coverage.grouping.subPlan [ string ]; # 0..1 Идентификатор подраздела плана  (медицинского обслуживания)
    fhir:Coverage.grouping.subPlanDisplay [ string ]; # 0..1 Display text for the subsection of the plan
    fhir:Coverage.grouping.class [ string ]; # 0..1 An identifier for the class
    fhir:Coverage.grouping.classDisplay [ string ]; # 0..1 Display text for the class
    fhir:Coverage.grouping.subClass [ string ]; # 0..1 An identifier for the subsection of the class
    fhir:Coverage.grouping.subClassDisplay [ string ]; # 0..1 Display text for the subsection of the subclass
  ];
  fhir:Coverage.dependent [ string ]; # 0..1 Номер материально зависимого лица
  fhir:Coverage.sequence [ string ]; # 0..1 Счетчик экземпляра плана или последовательности
  fhir:Coverage.order [ positiveInt ]; # 0..1 Relative order of the coverage
  fhir:Coverage.network [ string ]; # 0..1 Сеть страховых компаний
  fhir:Coverage.contract [ Reference(Contract) ], ... ; # 0..* Детали контракта
]

Changes since DSTU2

Coverage
Coverage.status
  • Added Element
Coverage.type
  • Type changed from Coding to CodeableConcept
Coverage.policyHolder
  • Added Element
Coverage.subscriber
  • Add Reference(RelatedPerson)
  • No longer marked as Modifier
Coverage.subscriberId
  • Type changed from Identifier to string
Coverage.beneficiary
  • Added Element
Coverage.relationship
  • Added Element
Coverage.payor
  • Added Element
Coverage.grouping
  • Added Element
Coverage.grouping.group
  • Added Element
Coverage.grouping.groupDisplay
  • Added Element
Coverage.grouping.subGroup
  • Added Element
Coverage.grouping.subGroupDisplay
  • Added Element
Coverage.grouping.plan
  • Added Element
Coverage.grouping.planDisplay
  • Added Element
Coverage.grouping.subPlan
  • Added Element
Coverage.grouping.subPlanDisplay
  • Added Element
Coverage.grouping.class
  • Added Element
Coverage.grouping.classDisplay
  • Added Element
Coverage.grouping.subClass
  • Added Element
Coverage.grouping.subClassDisplay
  • Added Element
Coverage.dependent
  • Type changed from positiveInt to string
Coverage.sequence
  • Type changed from positiveInt to string
Coverage.order
  • Added Element
Coverage.network
  • Type changed from Identifier to string
Coverage.issuer
  • deleted
Coverage.bin
  • deleted
Coverage.group
  • deleted
Coverage.plan
  • deleted
Coverage.subPlan
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

 

Альтернативные определения: Основное определение (XML, JSON), XML Schema/Schematron + JSON Schema, ShEx (for Turtle)

ПутьОписаниеТипСсылка
Coverage.status A code specifying the state of the resource instance.RequiredFinancial Resource Status Codes
Coverage.type The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.PreferredCoverage Type and Self-Pay Codes
Coverage.relationship The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).ExamplePolicyholder Relationship Codes

Параметры поиска для этого ресурса. Также к нему применяются общие параметры. Более подробную информацию о поиске в REST, обмене сообщениями и сервисах см. в разделе Поиск.

ИмяТипОписаниеВыражениеIn Common
beneficiaryreferenceСтрахуемая сторонаCoverage.beneficiary
(Patient)
classstringClass identifierCoverage.grouping.class
dependentstringНомер материально зависимого лицаCoverage.dependent
groupstringИдентификатор группыCoverage.grouping.group
identifiertokenОсновной идентификатор застрахованного и страхового покрытияCoverage.identifier
payorreferenceThe identity of the insurer or party paying for servicesCoverage.payor
(Organization, Patient, RelatedPerson)
planstringИдентификатор плана или полисаCoverage.grouping.plan
policy-holderreferenceReference to the policyholderCoverage.policyHolder
(Organization, Patient, RelatedPerson)
sequencestringПорядковый номерCoverage.sequence
statustokenThe status of the CoverageCoverage.status
subclassstringSub-class identifierCoverage.grouping.subClass
subgroupstringSub-group identifierCoverage.grouping.subGroup
subplanstringИдентификатор субпланаCoverage.grouping.subPlan
subscriberreferenceСсылка на подписчикаCoverage.subscriber
(Patient, RelatedPerson)
typetokenТип страхового покрытия (план медицинского обслуживания, автомобильное страхование, выплата компенсации работникам)Coverage.type