description: PCT Good Faith Estimate Summary is a profile for summarizing costs associated with a set of Good Faith Estimate Claims for a single Period of Care.
package_name: hl7.fhir.us.davinci
derivation: constraint
name: PCTGFESummary
type: Claim
elements:
  patient:
    type: Reference
    refers: ['http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics']
    index: 9
  insurance:
    elements:
      coverage:
        type: Reference
        refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage']
        index: 90
      preAuthRef: {index: 91}
  facility: {index: 27}
  diagnosis:
    mustSupport: true
    index: 45
    elements:
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTDiagnosisTypeVS'}
        mustSupport: true
        index: 46
    slicing:
      rules: open
      ordered: false
      description: Slice based on $this pattern
      discriminator:
      - {path: type, type: pattern}
      min: 1
      slices:
        principal:
          match:
            type:
              coding:
              - {code: principal, system: 'http://terminology.hl7.org/CodeSystem/ex-diagnosistype'}
          schema:
            _required: true
            index: 47
            elements:
              sequence:
                pattern: {type: PositiveInt, value: 1}
                index: 48
              diagnosis:
                choices: [diagnosisCodeableConcept]
                index: 50
              diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 51}
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: principal, system: 'http://terminology.hl7.org/CodeSystem/ex-diagnosistype'}
                index: 52
            required: [type]
        admitting:
          match:
            type:
              coding:
              - {code: admitting, system: 'http://terminology.hl7.org/CodeSystem/ex-diagnosistype'}
          schema:
            mustSupport: true
            index: 53
            elements:
              diagnosis:
                choices: [diagnosisCodeableConcept]
                index: 55
              diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 56}
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: admitting, system: 'http://terminology.hl7.org/CodeSystem/ex-diagnosistype'}
                index: 57
            required: [type]
        patientReasonForVisit:
          match:
            type:
              coding:
              - {code: patientReasonForVisit, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType'}
          schema:
            mustSupport: true
            array: true
            max: 3
            index: 58
            elements:
              diagnosis:
                choices: [diagnosisCodeableConcept]
                index: 60
              diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 61}
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: patientReasonForVisit, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType'}
                index: 62
            required: [type]
        externalcauseofinjury:
          match:
            type:
              coding:
              - {code: externalCauseOfInjury, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType'}
          schema:
            mustSupport: true
            array: true
            max: 12
            index: 63
            elements:
              diagnosis:
                choices: [diagnosisCodeableConcept]
                index: 65
              diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 66}
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: externalCauseOfInjury, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType'}
                index: 67
            required: [type]
        other:
          match:
            type:
              coding:
              - {code: other, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType'}
          schema:
            mustSupport: true
            array: true
            max: 24
            index: 68
            elements:
              diagnosis:
                mustSupport: true
                choices: [diagnosisCodeableConcept]
                index: 70
              diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 71}
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: other, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDiagnosisType'}
                index: 72
            required: [type]
  enterer: {index: 11}
  supportingInfo: {index: 44}
  use:
    pattern: {type: Code, value: predetermination}
    index: 8
  item: {index: 96}
  type:
    pattern:
      type: CodeableConcept
      value:
        coding:
        - {code: estimate-summary, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse'}
    index: 6
  procedure:
    mustSupport: true
    index: 73
    extensions:
      serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 1, max: 1, type: Extension, index: 75}
    elements:
      extension:
        index: 74
        slicing:
          rules: open
          ordered: false
          discriminator:
          - {path: url, type: value}
          min: 1
          slices:
            serviceDescription:
              match: {url: null}
              schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 75}
              min: 1
              max: 1
      type:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS'}
        mustSupport: true
        index: 76
    required: [extension]
    slicing:
      rules: open
      ordered: false
      description: Slice based on $this pattern
      discriminator:
      - {path: type, type: pattern}
      min: null
      slices:
        principal:
          match:
            type:
              coding:
              - {code: principal, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'}
          schema:
            short: Principal clinical procedure performed
            mustSupport: true
            index: 77
            extensions:
              serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 1, max: 1, type: Extension, index: 78}
            elements:
              extension:
                type: Extension
                url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
                index: 78
                slicing:
                  slices:
                    serviceDescription:
                      match: {}
                      schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 78}
                      min: 1
                      max: 1
              sequence:
                pattern: {type: PositiveInt, value: 1}
                index: 79
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: principal, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'}
                index: 80
              procedure:
                choices: [procedureCodeableConcept]
                index: 82
              procedureCodeableConcept: {type: CodeableConcept, choiceOf: procedure, index: 83}
            required: [type]
        other:
          match:
            type:
              coding:
              - {code: other, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'}
          schema:
            mustSupport: true
            array: true
            max: 24
            index: 84
            extensions:
              serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 1, max: 1, type: Extension, index: 85}
            elements:
              extension:
                type: Extension
                url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription
                index: 85
                slicing:
                  slices:
                    serviceDescription:
                      match: {}
                      schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 85}
                      min: 1
                      max: 1
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: other, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'}
                index: 86
              procedure:
                choices: [procedureCodeableConcept]
                index: 88
              procedureCodeableConcept: {type: CodeableConcept, choiceOf: procedure, index: 89}
            required: [type]
  extension:
    index: 0
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: url, type: value}
      min: null
      slices:
        gfeDisclaimer:
          match: {url: null}
          schema: {type: Extension, short: Disclaimers the patient should be made aware of regarding the estimate, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer', index: 1}
          min: 0
        serviceDescription:
          match: {url: null}
          schema: {type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 2}
          min: 0
          max: 1
  referral: {index: 26}
  total: {short: Total GFE Charges, index: 97}
  insurer:
    type: Reference
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization']
    index: 12
  fundsReserve: {index: 22}
  priority:
    binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'}
    index: 21
  accident:
    elements:
      location:
        choices: [locationAddress]
        index: 93
      locationAddress: {type: Address, choiceOf: location, index: 94}
      location[x]:
        elements:
          country:
            binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/iso3166-1-2'}
            index: 95
  payee: {index: 25}
  prescription: {index: 23}
  billablePeriod: {short: The full Period of Care for all services or products included in the estimate from the first event to the last event., mustSupport: true, index: 10}
  identifier:
    index: 3
    slicing:
      rules: open
      description: Slice based on $this pattern
      discriminator:
      - {path: type, type: pattern}
      min: null
      slices:
        INTER:
          match:
            type:
              coding:
              - {code: INTER, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType', display: Intermediary System Identifier}
          schema:
            short: Intermediary System Identifier
            array: true
            index: 4
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: INTER, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTIdentifierType', display: Intermediary System Identifier}
                index: 5
            required: [type]
  subType: {index: 7}
  provider:
    extensions:
      dataAbsentReason:
        url: http://hl7.org/fhir/StructureDefinition/data-absent-reason
        type: Extension
        index: 14
        elements:
          value:
            pattern: {type: Code, value: not-applicable}
            choices: []
            index: 16
    elements:
      extension:
        index: 13
        slicing:
          slices:
            dataAbsentReason:
              match: {}
              schema:
                type: Extension
                url: http://hl7.org/fhir/StructureDefinition/data-absent-reason
                index: 14
                elements:
                  value:
                    pattern: {type: Code, value: not-applicable}
                    choices: []
                    index: 16
      reference: {index: 17}
      type: {index: 18}
      identifier: {index: 19}
      display: {index: 20}
    required: [extension]
  originalPrescription: {index: 24}
  careTeam:
    mustSupport: true
    index: 28
    elements:
      provider:
        type: Reference
        refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization', 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner']
        index: 29
      role:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS'}
        index: 30
      qualification:
        binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role'}
        index: 31
    required: [role]
    slicing:
      rules: open
      ordered: false
      description: Slice based on $this pattern
      discriminator:
      - {path: role, type: pattern}
      min: null
      slices:
        attending:
          match:
            role:
              coding:
              - {code: attending, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
          schema:
            mustSupport: true
            index: 32
            elements:
              provider:
                type: Reference
                refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner']
                index: 33
              role:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: attending, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
                index: 34
              qualification: {index: 35}
            required: [qualification]
        operating:
          match:
            role:
              coding:
              - {code: operating, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
          schema:
            mustSupport: true
            array: true
            max: 2
            index: 36
            elements:
              provider:
                type: Reference
                refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner']
                index: 37
              role:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: operating, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
                index: 38
        rendering:
          match:
            role:
              coding:
              - {code: rendering, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
          schema:
            mustSupport: true
            index: 39
            elements:
              provider:
                type: Reference
                refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner']
                index: 40
              role:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: rendering, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
                index: 41
        referring:
          match:
            role:
              coding:
              - {code: referring, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
          schema:
            mustSupport: true
            index: 42
            elements:
              role:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: referring, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTCareTeamRole'}
                index: 43
package_version: pct-2.0.0-ballot
extensions:
  gfeDisclaimer: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer', min: 0, type: Extension, short: Disclaimers the patient should be made aware of regarding the estimate, mustSupport: true, index: 1}
  serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 0, max: 1, type: Extension, mustSupport: true, index: 2}
class: profile
kind: resource
url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-summary
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 2.0.0-ballot
required: [total, diagnosis]