{
"description": "Basis-Profil für die Nutzung der Coverage-Resource in Deutschland",
"_filename": "Profile-coverage-de-basis-0.2.json",
"package_name": "basisprofil.de",
"date": "2018-06-27",
"derivation": "constraint",
"meta": {
"lastUpdated": "2018-02-01T15:47:06.872-06:00"
},
"publisher": "HL7 Deutschland e.V. (Technisches Komitee FHIR)",
"fhirVersion": "3.0.1",
"purpose": "Coverage wird verwedet um Informationen über die Versicherung eines Patienten zu speichern/kommunizieren",
"name": "coverage-de-basis-0.2",
"abstract": false,
"copyright": "HL7 Deutschland e.V.",
"type": "Coverage",
"experimental": "true",
"resourceType": "StructureDefinition",
"title": "Coverage, deutsches Basisprofil (Version 0.2)",
"package_version": "0.2.40",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fm"
} ],
"snapshot": {
"element": [ {
"constraint": [ {
"key": "dom-2",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"xpath": "not(parent::f:contained and f:contained)",
"severity": "error",
"expression": "contained.contained.empty()"
}, {
"key": "dom-1",
"human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
"xpath": "not(parent::f:contained and f:text)",
"severity": "error",
"expression": "contained.text.empty()"
}, {
"key": "dom-4",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"severity": "error",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
}, {
"key": "dom-3",
"human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource",
"xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
"severity": "error",
"expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()"
} ],
"path": "Coverage",
"min": 0,
"definition": "Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte.",
"short": "Versicherungsdaten",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "Event",
"identity": "workflow"
}, {
"map": "Coverage",
"identity": "rim"
}, {
"map": "financial.support",
"identity": "w5"
} ],
"max": "*",
"id": "Coverage",
"base": {
"max": "*",
"min": 0,
"path": "Resource"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.id",
"min": 0,
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"short": "Logical id of this artifact",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "id"
} ],
"max": "1",
"id": "Coverage.id",
"condition": [ "ele-1" ],
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.id"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.meta",
"min": 0,
"definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
"short": "Metadata about the resource",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Meta"
} ],
"max": "1",
"id": "Coverage.meta",
"condition": [ "ele-1" ],
"base": {
"max": "1",
"min": 0,
"path": "Resource.meta"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.implicitRules",
"min": 0,
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
"isModifier": true,
"short": "A set of rules under which this content was created",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "uri"
} ],
"max": "1",
"id": "Coverage.implicitRules",
"condition": [ "ele-1" ],
"comment": "Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
"base": {
"max": "1",
"min": 0,
"path": "Resource.implicitRules"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.language",
"min": 0,
"definition": "The base language in which the resource is written.",
"short": "Language of the resource content",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "extensible",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueReference": {
"reference": "http://hl7.org/fhir/ValueSet/all-languages"
}
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
} ],
"description": "A human language.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/languages"
}
},
"max": "1",
"id": "Coverage.language",
"condition": [ "ele-1" ],
"comment": "Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
"base": {
"max": "1",
"min": 0,
"path": "Resource.language"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.text",
"min": 0,
"definition": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.",
"short": "Text summary of the resource, for human interpretation",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
}, {
"map": "Act.text?",
"identity": "rim"
} ],
"type": [ {
"code": "Narrative"
} ],
"alias": [ "narrative", "html", "xhtml", "display" ],
"max": "1",
"id": "Coverage.text",
"condition": [ "ele-1", "dom-1" ],
"comment": "Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.",
"base": {
"max": "1",
"min": 0,
"path": "DomainResource.text"
}
}, {
"path": "Coverage.contained",
"min": 0,
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"short": "Contained, inline Resources",
"mapping": [ {
"map": "Entity. Role, or Act",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Resource"
} ],
"alias": [ "inline resources", "anonymous resources", "contained resources" ],
"max": "*",
"id": "Coverage.contained",
"comment": "This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.contained"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "Coverage.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional Content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.extension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "Coverage.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.modifierExtension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "DomainResource.modifierExtension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.identifier",
"requirements": "This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below.",
"min": 0,
"definition": "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.dependant.",
"short": "The primary coverage ID",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
"identity": "v2"
}, {
"map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]",
"identity": "rim"
}, {
"map": "Identifier",
"identity": "servd"
}, {
"map": "Event.identifier",
"identity": "workflow"
}, {
"map": "C02",
"identity": "cdanetv4"
}, {
"map": "IN1-2",
"identity": "v2"
}, {
"map": "C.32, C.33, C.39",
"identity": "cpha3pharm"
}, {
"map": "id",
"identity": "w5"
} ],
"type": [ {
"code": "Identifier"
} ],
"max": "*",
"id": "Coverage.identifier",
"condition": [ "ele-1" ],
"base": {
"max": "*",
"min": 0,
"path": "Coverage.identifier"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.status",
"min": 1,
"definition": "The status of the resource instance.",
"isModifier": true,
"short": "active | cancelled | draft | entered-in-error",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "Event.status",
"identity": "workflow"
}, {
"map": "status",
"identity": "w5"
} ],
"type": [ {
"code": "code"
} ],
"binding": {
"strength": "required",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "CoverageStatus"
} ],
"description": "A code specifying the state of the resource instance.",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/fm-status"
}
},
"max": "1",
"id": "Coverage.status",
"condition": [ "ele-1" ],
"comment": "This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.status"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.type",
"requirements": "The order of application of coverages is dependent on the types of coverage.",
"min": 0,
"definition": "Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt",
"short": "Versicherungsart",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "IN1-15",
"identity": "v2"
}, {
"map": "class",
"identity": "w5"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "required",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "CoverageType"
} ],
"description": "Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt",
"valueSetUri": "http://fhir.de/ValueSet/versicherungsart-de-basis"
},
"max": "1",
"id": "Coverage.type",
"condition": [ "ele-1" ],
"comment": "28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dort igen Codes nicht passen.",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.type"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "Coverage.policyHolder",
"min": 0,
"definition": "The party who 'owns' the insurance policy, may be an individual, corporation or the subscriber's employer.",
"short": "Owner of the policy",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
} ],
"max": "0",
"id": "Coverage.policyHolder",
"condition": [ "ele-1" ],
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.policyHolder"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "Coverage.subscriber",
"min": 0,
"definition": "Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung",
"short": "Hauptversicherte Person / Mitglied",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
}, {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/patient-de-basis/0.2"
} ],
"max": "1",
"id": "Coverage.subscriber",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.subscriber"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.subscriberId",
"min": 0,
"definition": "The insurer assigned ID for the Subscriber.",
"short": "ID assigned to the Subscriber",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "string"
} ],
"max": "0",
"id": "Coverage.subscriberId",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.subscriberId"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "Coverage.beneficiary",
"min": 1,
"definition": "Person, auf die sich die Kostenübernahme bezieht (der Patient)",
"short": "Begünstigte Person",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "Event.subject",
"identity": "workflow"
}, {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19-name of insured, address, date of birth",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
}, {
"map": "who.focus",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/patient-de-basis/0.2"
} ],
"max": "1",
"id": "Coverage.beneficiary",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.beneficiary"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.relationship",
"requirements": "To determine relationship between the patient and the subscriber.",
"min": 0,
"definition": "The relationship of beneficiary (patient) to the subscriber.",
"short": "Beneficiary relationship to the Subscriber",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "CE/CNE/CWE",
"identity": "v2"
}, {
"map": "CD",
"identity": "rim"
}, {
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
"identity": "orim"
}, {
"map": "C03",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "CodeableConcept"
} ],
"binding": {
"strength": "example",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Relationship"
} ],
"description": "The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).",
"valueSetReference": {
"reference": "http://hl7.org/fhir/ValueSet/policyholder-relationship"
}
},
"max": "1",
"id": "Coverage.relationship",
"condition": [ "ele-1" ],
"comment": "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.relationship"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "per-1",
"human": "If present, start SHALL have a lower value than end",
"xpath": "not(exists(f:start)) or not(exists(f:end)) or (f:start/@value <= f:end/@value)",
"severity": "error",
"expression": "start.empty() or end.empty() or (start <= end)"
} ],
"path": "Coverage.period",
"min": 0,
"definition": "Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.",
"short": "Coverage start and end dates",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "DR",
"identity": "v2"
}, {
"map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]",
"identity": "rim"
}, {
"map": "Event.occurrence",
"identity": "workflow"
}, {
"map": "IN1-12 / IN1-13",
"identity": "v2"
}, {
"map": "when.done",
"identity": "w5"
} ],
"type": [ {
"code": "Period"
} ],
"max": "1",
"id": "Coverage.period",
"condition": [ "ele-1" ],
"comment": "This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\"). If duration is required, specify the type as Interval|Duration.",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.period"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "Coverage.payor",
"requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
"min": 1,
"definition": "Versicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt.",
"short": "Versicherer",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "A05",
"identity": "cdanetv4"
}, {
"map": "IN1-3",
"identity": "v2"
}, {
"map": "C.30",
"identity": "cpha3pharm"
}, {
"map": "who.author",
"identity": "w5"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/organization-de-basis"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
}, {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/patient-de-basis/0.2"
} ],
"max": "*",
"id": "Coverage.payor",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "*",
"min": 0,
"path": "Coverage.payor"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping",
"min": 0,
"definition": "A suite of underwrite specific classifiers, for example may be used to identify a class of coverage or employer group, Policy, Plan.",
"short": "Additional coverage classifications",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "BackboneElement"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Group"
} ],
"max": "0",
"id": "Coverage.grouping",
"condition": [ "ele-1" ],
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.id",
"min": 0,
"definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"short": "xml:id (or equivalent in JSON)",
"mapping": [ {
"map": "n/a",
"identity": "rim"
} ],
"type": [ {
"code": "string"
} ],
"representation": [ "xmlAttr" ],
"max": "1",
"id": "Coverage.grouping.id",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Element.id"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "Coverage.grouping.extension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.",
"short": "Additional Content defined by implementations",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"slicing": {
"rules": "open",
"description": "Extensions are always sliced by (at least) url",
"discriminator": [ {
"path": "url",
"type": "value"
} ]
},
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content" ],
"max": "*",
"id": "Coverage.grouping.extension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "Element.extension"
}
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ext-1",
"human": "Must have either extensions or value[x], not both",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
"severity": "error",
"expression": "extension.exists() != value.exists()"
} ],
"path": "Coverage.grouping.modifierExtension",
"min": 0,
"definition": "May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.",
"isModifier": true,
"short": "Extensions that cannot be ignored",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "N/A",
"identity": "rim"
} ],
"type": [ {
"code": "Extension"
} ],
"alias": [ "extensions", "user content", "modifiers" ],
"max": "*",
"id": "Coverage.grouping.modifierExtension",
"condition": [ "ele-1" ],
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"base": {
"max": "*",
"min": 0,
"path": "BackboneElement.modifierExtension"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.group",
"min": 0,
"definition": "Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify an employer group. May also be referred to as a Policy or Group ID.",
"short": "An identifier for the group",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C11 (Division,Section)",
"identity": "cdanetv4"
}, {
"map": "IN1-8",
"identity": "v2"
}, {
"map": "C.31",
"identity": "cpha3pharm"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.group",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.group"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.groupDisplay",
"min": 0,
"definition": "A short description for the group.",
"short": "Display text for an identifier for the group",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C11 (Division,Section)",
"identity": "cdanetv4"
}, {
"map": "IN1-8",
"identity": "v2"
}, {
"map": "C.31",
"identity": "cpha3pharm"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.groupDisplay",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.groupDisplay"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.subGroup",
"min": 0,
"definition": "Identifies a style or collective of coverage issued by the underwriter, for example may be used to identify a subset of an employer group.",
"short": "An identifier for the subsection of the group",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "IN1-8",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subGroup",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subGroup"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.subGroupDisplay",
"min": 0,
"definition": "A short description for the subgroup.",
"short": "Display text for the subsection of the group",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "IN1-8",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subGroupDisplay",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subGroupDisplay"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.plan",
"min": 0,
"definition": "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 ID.",
"short": "An identifier for the plan",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.plan",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.plan"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.planDisplay",
"min": 0,
"definition": "A short description for the plan.",
"short": "Display text for the plan",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.planDisplay",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.planDisplay"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.subPlan",
"min": 0,
"definition": "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 employees.",
"short": "An identifier for the subsection of the plan",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "IN1-10",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subPlan",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subPlan"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.subPlanDisplay",
"min": 0,
"definition": "A short description for the subplan.",
"short": "Display text for the subsection of the plan",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "IN1-10",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subPlanDisplay",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subPlanDisplay"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.class",
"min": 0,
"definition": "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-payment.",
"short": "An identifier for the class",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.class",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.class"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.classDisplay",
"min": 0,
"definition": "A short description for the class.",
"short": "Display text for the class",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.classDisplay",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.classDisplay"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.subClass",
"min": 0,
"definition": "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-payment.",
"short": "An identifier for the subsection of the class",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subClass",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subClass"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.grouping.subClassDisplay",
"min": 0,
"definition": "A short description for the subclass.",
"short": "Display text for the subsection of the subclass",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C01",
"identity": "cdanetv4"
}, {
"map": "IN1-35",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "1",
"id": "Coverage.grouping.subClassDisplay",
"condition": [ "ele-1" ],
"comment": "Note that FHIR strings may not exceed 1MB in size",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.grouping.subClassDisplay"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.dependent",
"requirements": "For some coverage a single identifier is issued to the Subscriber and a dependent number issued to each beneficiary.",
"min": 0,
"definition": "Identifikation einer unter dieser Police versicherten Partei\r\nBsp: eine Familie ist mit der Police mit dem Identifier \"12345\" versichert\r\nVater 12345a\r\nMutter 12345b\r\nKind 12345c\r\na, b und c wären dann jeweils die \"dependents\"",
"short": "Dependent number",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "C17",
"identity": "cdanetv4"
}, {
"map": "- No exact HL7 v2 equivalent concept seems to exist;",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "0",
"id": "Coverage.dependent",
"condition": [ "ele-1" ],
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.dependent"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.sequence",
"requirements": "Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'.",
"min": 0,
"definition": "An optional counter for a particular instance of the identified coverage which increments upon each renewal.",
"short": "The plan instance or sequence counter",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "D11",
"identity": "cdanetv4"
}, {
"map": "No HL7 v2 equivalent concept seems to exist",
"identity": "v2"
} ],
"type": [ {
"code": "string"
} ],
"max": "0",
"id": "Coverage.sequence",
"condition": [ "ele-1" ],
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.sequence"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.order",
"min": 0,
"definition": "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 care.",
"short": "Relative order of the coverage",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "- No exact HL7 v2 equivalent concept seems to exist;",
"identity": "v2"
} ],
"type": [ {
"code": "positiveInt"
} ],
"max": "0",
"id": "Coverage.order",
"condition": [ "ele-1" ],
"comment": "Es git derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFür die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann.\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.order"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
} ],
"path": "Coverage.network",
"min": 0,
"definition": "Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden",
"short": "Insurer network",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "D10",
"identity": "cdanetv4"
} ],
"type": [ {
"code": "string"
} ],
"max": "0",
"id": "Coverage.network",
"condition": [ "ele-1" ],
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"base": {
"max": "1",
"min": 0,
"path": "Coverage.network"
},
"isSummary": true
}, {
"constraint": [ {
"key": "ele-1",
"human": "All FHIR elements must have a @value or children",
"xpath": "@value|f:*|h:div",
"severity": "error",
"expression": "hasValue() | (children().count() > id.count())"
}, {
"key": "ref-1",
"human": "SHALL have a contained resource if a local reference is provided",
"xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
"severity": "error",
"expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
} ],
"path": "Coverage.contract",
"min": 0,
"definition": "The policy(s) which constitute this insurance coverage.",
"short": "Contract details",
"mapping": [ {
"map": "n/a",
"identity": "rim"
}, {
"map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
"identity": "rim"
}, {
"map": "D01 through D09",
"identity": "cdanetv4"
}, {
"map": "IN1-16, 18, 19",
"identity": "v2"
}, {
"map": "C.35",
"identity": "cpha3pharm"
} ],
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/Contract"
} ],
"max": "*",
"id": "Coverage.contract",
"condition": [ "ele-1" ],
"comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
"base": {
"max": "*",
"min": 0,
"path": "Coverage.contract"
}
} ]
},
"status": "draft",
"id": "7d0f70ab-5b37-4266-a012-ff9bc42d41a8",
"kind": "resource",
"url": "http://fhir.de/StructureDefinition/coverage-de-basis/0.2",
"version": "0.2.4",
"differential": {
"element": [ {
"id": "Coverage",
"path": "Coverage",
"short": "Versicherungsdaten",
"definition": "Angaben zur Versicherung oder zur Kostenübernahme durch den Patienten selbst oder durch Dritte."
}, {
"id": "Coverage.status",
"min": 1,
"path": "Coverage.status"
}, {
"id": "Coverage.type",
"path": "Coverage.type",
"short": "Versicherungsart",
"binding": {
"strength": "required",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "CoverageType"
} ],
"description": "Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt",
"valueSetUri": "http://fhir.de/ValueSet/versicherungsart-de-basis"
},
"comment": "28.07.2017 (zulip): TC Konsens bzgl. Verwendung eines eigenen ValueSets anstelle des im Standrad definierten preferred bindings, da die dort igen Codes nicht passen.",
"definition": "Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt"
}, {
"id": "Coverage.policyHolder",
"max": "0",
"path": "Coverage.policyHolder",
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org"
}, {
"id": "Coverage.subscriber",
"path": "Coverage.subscriber",
"type": [ {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
}, {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/patient-de-basis/0.2"
} ],
"short": "Hauptversicherte Person / Mitglied",
"definition": "Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung"
}, {
"id": "Coverage.subscriberId",
"max": "0",
"path": "Coverage.subscriberId"
}, {
"id": "Coverage.beneficiary",
"min": 1,
"path": "Coverage.beneficiary",
"type": [ {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/patient-de-basis/0.2"
} ],
"short": "Begünstigte Person",
"definition": "Person, auf die sich die Kostenübernahme bezieht (der Patient)"
}, {
"id": "Coverage.payor",
"min": 1,
"path": "Coverage.payor",
"type": [ {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/organization-de-basis/0.2"
}, {
"code": "Reference",
"targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
}, {
"code": "Reference",
"targetProfile": "http://fhir.de/StructureDefinition/patient-de-basis/0.2"
} ],
"short": "Versicherer",
"definition": "Versicherer, der die Police ausgegeben hat oder Persopn/Organisation, die die Kosten übernimmt."
}, {
"id": "Coverage.grouping",
"max": "0",
"path": "Coverage.grouping",
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
"valueString": "Group"
} ]
}, {
"id": "Coverage.dependent",
"max": "0",
"path": "Coverage.dependent",
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"definition": "Identifikation einer unter dieser Police versicherten Partei\r\nBsp: eine Familie ist mit der Police mit dem Identifier \"12345\" versichert\r\nVater 12345a\r\nMutter 12345b\r\nKind 12345c\r\na, b und c wären dann jeweils die \"dependents\""
}, {
"id": "Coverage.sequence",
"max": "0",
"path": "Coverage.sequence",
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org"
}, {
"id": "Coverage.order",
"max": "0",
"path": "Coverage.order",
"comment": "Es git derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFür die Priorisierung der Versicherungsverhältnisse sollte statt dessen Account.coverage.priority verwendet werden, da die Priorisierung abhängig von Fall- und Abrechnungsart unterschiedlich sein kann.\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org"
}, {
"id": "Coverage.network",
"max": "0",
"path": "Coverage.network",
"comment": "Es gibt derzeit in DE keine Verwendung für dieses Attribut\r\n(Konsens Interop-Forum 12.6.2017)\r\nFalls es UseCases gibt, die dieses Attribut benötigen, bitte Info auf chat.fhir.org",
"definition": "Die Versicherungsleistungen sind an ein bestimmtes Netzwerk von Gesundheitsdienstleistern gebunden"
} ]
},
"contact": [ {
"telecom": [ {
"value": "http://hl7.de/technische-komitees/fhir/",
"system": "other"
} ]
} ],
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage"
}