OPENIMIS.FHIR.R4\openIMIS Coverage

openIMIS FHIR R4 Implementation Guide - Local Development build (v1.0.0). See the Directory of published versions

Resource Profile: openIMIS Coverage

Official URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/openimis-coverage				Version: 1.0.0
Active as of 2022-05-31			Responsible: openIMIS Initiative	Computable Name: OpenIMISCoverage

Defines a Coverage for openIMIS which maps to a Policy.

Usage:

Refer to this Resource Profile:
Examples for this Resource Profile: Coverage/JoeDoeCoverage

Formal Views of Profile Content

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

This structure is derived from Coverage

Summary

Mandatory: 11 elements (1 nested mandatory element)
Must-Support: 1 element
Prohibited: 10 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date

Slices

This structure defines the following Slices:

The element Coverage.identifier is sliced based on the value of value:type.coding.code (Closed)

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id		0..1	string	Coverage UUID
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
coverage-date		1..1	date	Enrollment Date URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date
coverage-date		1..1	date	Effective Date URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date
Slices for identifier	S	1..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:type.coding.code
identifier:All Slices				Content/Rules for all slices
type		1..1	CodeableConcept	Description of identifier
coding
code		0..1	code	Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required)
value		1..1	string	The value that is unique
identifier:UUID		1..1	Identifier	Business Identifier for the coverage
type
coding
code		1..1	code	Coverage openIMIS UUID Required Pattern: UUID
status		1..1	code	Coverage Status Binding: Coverage Status (Coverage) (required)
type		0..0
policyHolder		0..1	Reference(openIMIS Patient)	Owner of the policy
subscriber		0..0
subscriberId		0..0
beneficiary		1..1	Reference(openIMIS Patient)	Plan beneficiary
dependent		0..0
relationship		0..0
period		1..1	Period	Coverage start and end dates
start		1..1	dateTime	Start date
end		1..1	dateTime	Expiry date
payor		1..1	Reference(openIMIS Patient \| openIMIS Policy Holder Organization)	Issuer of the policy
class		1..1	BackboneElement	Additional coverage classifications
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		1..1	string	Representation defined by the system Fixed Value: Plan
value		1..1	string	Product Code
name		1..1	string	Product Name
order		0..0
network		0..0
costToBeneficiary		0..0
subrogation		0..0
contract		0..0
Documentation for this format

Description & Constraints

Coverage

0..*

Coverage

Insurance or medical plan or a payment agreement

0..1

string

Coverage UUID

Meta

Metadata about the resource

implicitRules

?!Σ

0..1

uri

A set of rules under which this content was created

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

AllLanguages

Max Binding

text

0..1

Narrative

Text summary of the resource, for human interpretation

contained

0..*

Resource

Contained, inline Resources

Slices for extension

2..*

Extension

Extension
Slice: Unordered, Open by value:url

coverage-date

1..1

date

Enrollment Date
URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date

coverage-date

1..1

date

Effective Date
URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date

modifierExtension

0..*

Extension

Extensions that cannot be ignored

Slices for identifier

SΣ

1..1

Identifier

Business Identifier for the coverage
Slice: Unordered, Closed by value:type.coding.code

identifier:All Slices

Content/Rules for all slices

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

use

?!Σ

0..1

code

usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

type

1..1

CodeableConcept

Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

coding

0..*

Coding

Code defined by a terminology system

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

system

0..1

uri

Identity of the terminology system

version

0..1

string

Version of the system - if relevant

code

0..1

code

Symbol in syntax defined by the system
Binding: openIMIS Identifiers Value Set (required)

display

0..1

string

Representation defined by the system

userSelected

0..1

boolean

If this coding was chosen directly by the user

text

0..1

string

Plain text representation of the concept

system

0..1

uri

The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient

value

1..1

string

The value that is unique
Example General: 123456

period

0..1

Period

Time period when id is/was valid for use

assigner

0..1

Reference(Organization)

Organization that issued id (may be just text)

identifier:UUID

1..1

Identifier

Business Identifier for the coverage

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

use

?!Σ

0..1

code

usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

type

0..1

CodeableConcept

Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

coding

0..*

Coding

Code defined by a terminology system

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

system

0..1

uri

Identity of the terminology system

version

0..1

string

Version of the system - if relevant

code

1..1

code

Coverage openIMIS UUID
Required Pattern: UUID

display

0..1

string

Representation defined by the system

userSelected

0..1

boolean

If this coding was chosen directly by the user

text

0..1

string

Plain text representation of the concept

system

0..1

uri

The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient

value

0..1

string

The value that is unique
Example General: 123456

period

0..1

Period

Time period when id is/was valid for use

assigner

0..1

Reference(Organization)

Organization that issued id (may be just text)

status

?!Σ

1..1

code

Coverage Status
Binding: Coverage Status (Coverage) (required)

policyHolder

0..1

Reference(openIMIS Patient)

Owner of the policy

beneficiary

1..1

Reference(openIMIS Patient)

Plan beneficiary

period

1..1

Period

Coverage start and end dates

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations
Slice: Unordered, Open by value:url

start

ΣI

1..1

dateTime

Start date

end

ΣI

1..1

dateTime

Expiry date

payor

1..1

Reference(openIMIS Patient | openIMIS Policy Holder Organization)

Issuer of the policy

class

1..1

BackboneElement

Additional coverage classifications

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

1..1

CodeableConcept

Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

Required Pattern: At least the following

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations

coding

1..*

Coding

Code defined by a terminology system
Fixed Value: (complex)

0..1

string

Unique id for inter-element referencing

extension

0..*

Extension

Additional content defined by implementations

system

1..1

uri

Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class

version

0..1

string

Version of the system - if relevant

code

1..1

code

Symbol in syntax defined by the system
Fixed Value: plan

display

1..1

string

Representation defined by the system
Fixed Value: Plan

userSelected

0..1

boolean

If this coding was chosen directly by the user

text

0..1

string

Plain text representation of the concept

value

1..1

string

Product Code

name

1..1

string

Product Name

Documentation for this format

This structure is derived from Coverage

Summary

Mandatory: 11 elements (1 nested mandatory element)
Must-Support: 1 element
Prohibited: 10 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date

Slices

This structure defines the following Slices:

The element Coverage.identifier is sliced based on the value of value:type.coding.code (Closed)

Differential View

This structure is derived from Coverage

Name	Flags	Card.	Type	Description & Constraints
Coverage		0..*	Coverage	Insurance or medical plan or a payment agreement
id		0..1	string	Coverage UUID
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
coverage-date		1..1	date	Enrollment Date URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date
coverage-date		1..1	date	Effective Date URL: https://openimis.github.io/openimis_fhir_r4_ig/StructureDefinition/coverage-date
Slices for identifier	S	1..1	Identifier	Business Identifier for the coverage Slice: Unordered, Closed by value:type.coding.code
identifier:All Slices				Content/Rules for all slices
type		1..1	CodeableConcept	Description of identifier
coding
code		0..1	code	Symbol in syntax defined by the system Binding: openIMIS Identifiers Value Set (required)
value		1..1	string	The value that is unique
identifier:UUID		1..1	Identifier	Business Identifier for the coverage
type
coding
code		1..1	code	Coverage openIMIS UUID Required Pattern: UUID
status		1..1	code	Coverage Status Binding: Coverage Status (Coverage) (required)
type		0..0
policyHolder		0..1	Reference(openIMIS Patient)	Owner of the policy
subscriber		0..0
subscriberId		0..0
beneficiary		1..1	Reference(openIMIS Patient)	Plan beneficiary
dependent		0..0
relationship		0..0
period		1..1	Period	Coverage start and end dates
start		1..1	dateTime	Start date
end		1..1	dateTime	Expiry date
payor		1..1	Reference(openIMIS Patient \| openIMIS Policy Holder Organization)	Issuer of the policy
class		1..1	BackboneElement	Additional coverage classifications
type		1..1	CodeableConcept	Type of class such as 'group' or 'plan' Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
code		1..1	code	Symbol in syntax defined by the system Fixed Value: plan
display		1..1	string	Representation defined by the system Fixed Value: Plan
value		1..1	string	Product Code
name		1..1	string	Product Name
order		0..0
network		0..0
costToBeneficiary		0..0
subrogation		0..0
contract		0..0
Documentation for this format

Snapshot View

Description & Constraints

Coverage

0..*

Coverage

Insurance or medical plan or a payment agreement

0..1

string

Coverage UUID

Terminology Bindings

Path	Conformance	ValueSet / Code
Coverage.language	preferred	CommonLanguages Max Binding: AllLanguages
Coverage.identifier.use	required	IdentifierUse
Coverage.identifier.type	extensible	Identifier Type Codes
Coverage.identifier.type.coding.code	required	OpenIMISIdentifierVS
Coverage.identifier:UUID.use	required	IdentifierUse
Coverage.identifier:UUID.type	extensible	Identifier Type Codes
Coverage.status	required	CoverageStatusVS
Coverage.class.type	extensible	Pattern: plan("Plan")
Coverage.costToBeneficiary.type	extensible	CoverageCopayTypeCodes
Coverage.costToBeneficiary.exception.type	example	ExampleCoverageFinancialExceptionCodes

Constraints

Id	Grade	Path	Details	Requirements
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	Coverage.meta	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.implicitRules	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.language	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.extension:enrollDate	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.extension:enrollDate	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.extension:effectiveDate	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.extension:effectiveDate	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.identifier	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.identifier.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.identifier.use	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.identifier.type.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.identifier.type.coding	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type.coding.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.identifier.type.coding.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.identifier.type.coding.system	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type.coding.version	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type.coding.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type.coding.display	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type.coding.userSelected	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.type.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.system	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.value	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier.assigner	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.identifier:UUID.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.identifier:UUID.use	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.identifier:UUID.type.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.identifier:UUID.type.coding	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type.coding.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.identifier:UUID.type.coding.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.identifier:UUID.type.coding.system	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type.coding.version	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type.coding.code	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type.coding.display	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type.coding.userSelected	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.type.text	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.system	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.value	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.identifier:UUID.assigner	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.status	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.policyHolder	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.beneficiary	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.period.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.period.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.period.start	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.period.end	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.payor	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.class	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.class.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.class.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.class.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.class.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.class.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.class.value	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.class.name	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.costToBeneficiary.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.costToBeneficiary.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.costToBeneficiary.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.costToBeneficiary.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.costToBeneficiary.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.costToBeneficiary.value[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.costToBeneficiary.exception	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.costToBeneficiary.exception.extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.costToBeneficiary.exception.extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.costToBeneficiary.exception.modifierExtension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	Coverage.costToBeneficiary.exception.modifierExtension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	error	Coverage.costToBeneficiary.exception.type	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ele-1	error	Coverage.costToBeneficiary.exception.period	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())