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-pct derivation: constraint name: PCTGFESummary type: Claim elements: patient: type: Reference refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|7.0.0'] index: 6 insurance: elements: coverage: type: Reference refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-coverage'] index: 93 preAuthRef: {index: 94} facility: {index: 24} diagnosis: mustSupport: true index: 42 elements: type: binding: {strength: required, valueSet: 'http://terminology.hl7.org/ValueSet/diagnosistype'} mustSupport: true index: 43 slicing: rules: open ordered: false description: Slice based on $this value discriminator: - {path: type, type: value} min: null slices: principal: match: type: coding: - {code: principal, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} schema: short: Principal Diagnosis - Must Support means the information source SHALL be capable of populating and SHALL populate if available and permitted. mustSupport: true index: 44 elements: sequence: pattern: {type: PositiveInt, value: 1} index: 45 diagnosis: choices: [diagnosisCodeableConcept] index: 47 diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 48} type: pattern: type: CodeableConcept value: coding: - {code: principal, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} index: 49 required: [type] admitting: match: type: coding: - {code: admitting, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} schema: mustSupport: true index: 50 elements: diagnosis: choices: [diagnosisCodeableConcept] index: 52 diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 53} type: pattern: type: CodeableConcept value: coding: - {code: admitting, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} index: 54 required: [type] patientReasonForVisit: match: type: coding: - {code: patientreasonforvisit, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} schema: mustSupport: true array: true max: 3 index: 55 elements: diagnosis: choices: [diagnosisCodeableConcept] index: 57 diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 58} type: pattern: type: CodeableConcept value: coding: - {code: patientreasonforvisit, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} index: 59 required: [type] externalcauseofinjury: match: type: coding: - {code: externalcauseofinjury, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} schema: mustSupport: true array: true max: 12 index: 60 elements: diagnosis: choices: [diagnosisCodeableConcept] index: 62 diagnosisCodeableConcept: {type: CodeableConcept, choiceOf: diagnosis, index: 63} type: pattern: type: CodeableConcept value: coding: - {code: externalcauseofinjury, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} index: 64 required: [type] other: match: type: coding: - {code: secondary, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} schema: mustSupport: true array: true max: 24 index: 65 elements: diagnosis: mustSupport: true choices: [diagnosisCodeableConcept] index: 67 diagnosisCodeableConcept: {type: CodeableConcept, mustSupport: true, choiceOf: diagnosis, index: 68} type: pattern: type: CodeableConcept value: coding: - {code: secondary, system: 'http://terminology.hl7.org/CodeSystem/diagnosistype'} index: 69 required: [type] enterer: {index: 8} supportingInfo: {index: 41} use: pattern: {type: Code, value: predetermination} index: 5 item: {index: 99} type: pattern: type: CodeableConcept value: coding: - {code: estimate-summary, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTEstimateTypeSummaryCSTemporaryTrialUse'} index: 3 procedure: mustSupport: true index: 70 extensions: serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 1, max: 1, type: Extension, index: 72} elements: extension: index: 71 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: 72} min: 1 max: 1 type: binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTProcedureTypeVS'} mustSupport: true index: 73 required: [extension] slicing: rules: open ordered: false description: Slice based on $this value discriminator: - {path: type, type: value} 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: 74 extensions: serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 1, max: 1, type: Extension, index: 75} elements: extension: type: Extension url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription index: 75 slicing: slices: serviceDescription: match: {} schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 75} min: 1 max: 1 sequence: pattern: {type: PositiveInt, value: 1} index: 76 type: pattern: type: CodeableConcept value: coding: - {code: principal, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'} index: 77 procedure: choices: [procedureCodeableConcept] index: 79 procedureCodeableConcept: {type: CodeableConcept, choiceOf: procedure, index: 80} required: [type] anesthesiaRelated: match: type: coding: - {code: procedureRequiringAnesthesia, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'} schema: mustSupport: true array: true max: 2 index: 81 extensions: serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 1, max: 1, type: Extension, index: 82} elements: extension: type: Extension url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription index: 82 slicing: slices: serviceDescription: match: {} schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 82} min: 1 max: 1 type: pattern: type: CodeableConcept value: coding: - {code: procedureRequiringAnesthesia, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'} index: 83 procedure: choices: [procedureCodeableConcept] index: 85 procedureCodeableConcept: {type: CodeableConcept, choiceOf: procedure, index: 86} 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: 87 extensions: serviceDescription: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', min: 1, max: 1, type: Extension, index: 88} elements: extension: type: Extension url: http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription index: 88 slicing: slices: serviceDescription: match: {} schema: {type: Extension, url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription', index: 88} min: 1 max: 1 type: pattern: type: CodeableConcept value: coding: - {code: other, system: 'http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTProcedureType'} index: 89 procedure: choices: [procedureCodeableConcept] index: 91 procedureCodeableConcept: {type: CodeableConcept, choiceOf: procedure, index: 92} required: [type] extension: index: 0 slicing: rules: open ordered: false discriminator: - {path: url, type: value} min: null slices: gfeDisclaimer: match: {url: null} schema: {short: 'Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients', type: Extension, 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: 23} total: {short: Total GFE Charges, index: 100} insurer: type: Reference mustSupport: true refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-organization'] index: 9 fundsReserve: {index: 19} priority: binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/process-priority'} index: 18 accident: elements: location: choices: [locationAddress] index: 96 locationAddress: {type: Address, choiceOf: location, index: 97} location[x]: elements: country: binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/iso3166-1-2'} index: 98 payee: {index: 22} prescription: {index: 20} 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: 7} subType: {index: 4} provider: extensions: dataAbsentReason: url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0 type: Extension index: 11 elements: value: pattern: {type: Code, value: not-applicable} choices: [] index: 13 elements: extension: index: 10 slicing: slices: dataAbsentReason: match: {} schema: type: Extension url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0 index: 11 elements: value: pattern: {type: Code, value: not-applicable} choices: [] index: 13 reference: {index: 14} type: {index: 15} identifier: {index: 16} display: {index: 17} required: [extension] originalPrescription: {index: 21} careTeam: mustSupport: true index: 25 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: 26 role: binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/davinci-pct/ValueSet/PCTCareTeamRoleVS'} index: 27 qualification: binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/core/ValueSet/us-core-provider-role'} index: 28 required: [role] slicing: rules: open ordered: false description: Slice based on $this value discriminator: - {path: role, type: value} min: null slices: attending: match: role: coding: - {code: attending, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} schema: mustSupport: true index: 29 elements: provider: type: Reference refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner'] index: 30 role: pattern: type: CodeableConcept value: coding: - {code: attending, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} index: 31 qualification: {index: 32} required: [qualification] operating: match: role: coding: - {code: operating, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} schema: mustSupport: true array: true max: 2 index: 33 elements: provider: type: Reference refers: ['http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-practitioner'] index: 34 role: pattern: type: CodeableConcept value: coding: - {code: operating, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} index: 35 rendering: match: role: coding: - {code: rendering, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} schema: mustSupport: true 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: rendering, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} index: 38 referring: match: role: coding: - {code: referring, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} schema: mustSupport: true index: 39 elements: role: pattern: type: CodeableConcept value: coding: - {code: referring, system: 'http://terminology.hl7.org/CodeSystem/claimcareteamrole', version: 1.0.1} index: 40 package_version: 2.0.0 extensions: gfeDisclaimer: {url: 'http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeDisclaimer', min: 0, short: 'Disclaimers the patient should be made aware of regarding the estimate, e.g. application of sliding scale for self-pay/uninsured patients', type: Extension, 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 required: [total]