{
  "description": null,
  "_filename": "Questionnaire-ch-orf-module-coverage.json",
  "package_name": "ch.fhir.ig.ch-orf",
  "date": "2022-05-04",
  "publisher": "HL7 Switzerland",
  "jurisdiction": [ {
    "coding": [ {
      "code": "CH",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "ModuleQuestionnaireOrderCoverage",
  "item": [ {
    "item": [ {
      "text": "AHV-Nr. des Patienten (fr/it: AVS)",
      "type": "string",
      "linkId": "coverage.beneficiary.ahvn13",
      "definition": "http://fhir.ch/ig/ch-core/StructureDefinition/ch-core-patient#Patient.identifier:AHVN13"
    } ],
    "text": "Begünstigter (Patient)",
    "type": "group",
    "linkId": "coverage.beneficiary",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.beneficiary"
  }, {
    "item": [ {
      "text": "Name der Versicherung",
      "type": "string",
      "linkId": "coverage.kvg.name",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
    }, {
      "text": "Kennnummer der Versichertenkarte",
      "type": "string",
      "linkId": "coverage.kvg.insuranceCardNumber",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
    } ],
    "text": "Krankenkasse nach KVG (fr/it: LAMal)",
    "type": "group",
    "linkId": "coverage.kvg",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
  }, {
    "item": [ {
      "text": "Name der Versicherung",
      "type": "string",
      "linkId": "coverage.uvg.name",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
    }, {
      "text": "Schadennummer",
      "type": "string",
      "linkId": "coverage.uvg.claimNumber",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
    } ],
    "text": "Unfallversicherung nach UVG (fr: LAA, it: LAINF)",
    "type": "group",
    "linkId": "coverage.uvg",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
  }, {
    "item": [ {
      "text": "Name der Versicherung",
      "type": "string",
      "linkId": "coverage.vvg.name",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
    }, {
      "text": "Kennnummer der Versichertenkarte",
      "type": "string",
      "linkId": "coverage.vvg.insuranceCardNumber",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
    } ],
    "text": "Zusatzversicherung nach VVG (fr/it: LCA)",
    "type": "group",
    "linkId": "coverage.vvg",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
  }, {
    "item": [ {
      "text": "IV-Verfügungsnummer",
      "type": "string",
      "linkId": "coverage.iv.verfuegungsnummer",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
    } ],
    "text": "Invalidenversicherung IV (fr/it: AI)",
    "type": "group",
    "linkId": "coverage.iv",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
  }, {
    "item": [ {
      "text": "MV-Versichertennummer",
      "type": "string",
      "linkId": "coverage.mv.versichertennummer",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
    } ],
    "text": "Militärversicherung MV (fr/it: AM)",
    "type": "group",
    "linkId": "coverage.mv",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
  }, {
    "item": [ {
      "text": "Patient selbst",
      "type": "boolean",
      "linkId": "coverage.self.patient",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
    }, {
      "text": "Andere Person",
      "type": "boolean",
      "linkId": "coverage.self.patientRelatedPerson",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor",
      "enableWhen": [ {
        "operator": "=",
        "question": "coverage.self.patient",
        "answerBoolean": false
      } ]
    }, {
      "item": [ {
        "text": "Name",
        "type": "string",
        "linkId": "coverage.self.relatedPerson.familyName",
        "definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#RelatedPerson.name.family"
      }, {
        "text": "Vorname",
        "type": "string",
        "linkId": "coverage.self.relatedPerson.givenName",
        "definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#RelatedPerson.name.given"
      }, {
        "text": "Telefon",
        "type": "string",
        "linkId": "coverage.self.relatedPerson.phone",
        "repeats": true,
        "definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#RelatedPerson.telecom.value"
      }, {
        "text": "E-Mail",
        "type": "string",
        "linkId": "coverage.self.relatedPerson.email",
        "definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#RelatedPerson.telecom.value"
      }, {
        "text": "Unable to resolve 'address' sub-questionnaire",
        "type": "display",
        "linkId": "coverage.self.relatedPerson.1",
        "extension": [ {
          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-subQuestionnaire",
          "valueCanonical": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-address|3.0.0-ci-build"
        } ]
      } ],
      "text": "Andere Person",
      "type": "group",
      "linkId": "coverage.self.relatedPerson",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/variable",
        "valueExpression": {
          "name": "linkIdPrefix",
          "language": "text/fhirpath",
          "expression": "'coverage.self.relatedPerson.'"
        }
      } ],
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor",
      "enableWhen": [ {
        "operator": "=",
        "question": "coverage.self.patientRelatedPerson",
        "answerBoolean": true
      } ]
    } ],
    "text": "Selbstzahler",
    "type": "group",
    "linkId": "coverage.self",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
  }, {
    "item": [ {
      "text": "Name des Kostenträgers",
      "type": "string",
      "linkId": "coverage.other.name",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.payor"
    }, {
      "text": "Beliebige ID",
      "type": "string",
      "linkId": "coverage.other.id",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier"
    }, {
      "text": "Bemerkung zur ID",
      "type": "string",
      "linkId": "coverage.other.id.note",
      "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.identifier.type.text"
    } ],
    "text": "Anderer Kostenträger",
    "type": "group",
    "linkId": "coverage.other",
    "definition": "http://fhir.ch/ig/ch-orf/StructureDefinition/ch-orf-coverage#Coverage.type"
  } ],
  "copyright": "CC0-1.0",
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "Module Questionnaire Order Coverage",
  "package_version": "3.0.0",
  "extension": [ {
    "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-assemble-expectation",
    "valueCode": "assemble-child"
  } ],
  "status": "active",
  "language": "de-CH",
  "id": "322de7b8-c250-493f-8e50-5467b2a1fcf1",
  "kind": null,
  "url": "http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-coverage",
  "version": "3.0.0",
  "contact": [ {
    "name": "HL7 Switzerland",
    "telecom": [ {
      "value": "https://www.hl7.ch/",
      "system": "url"
    } ]
  } ]
}