FHIR Release 3 (STU) CI-Build

This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0 . For a full list Continuous Integration Build of available versions, see FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions . Page versions: R5 R4B R4 R3

Coverage-example-selfpay.json

Example Coverage/SP1234 (JSON)

Maturity Level : N/A
Responsible Owner: Financial Management Work Group Ballot Standards Status : Informative Compartments : Patient , RelatedPerson

Raw JSON ( canonical form + also see JSON Format Specification )

Self Payment Example 

{
  "resourceType": "Coverage",
  "id": "SP1234",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of a Self Pay Agreement.</div>"

  "resourceType" : "Coverage",
  "id" : "SP1234",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of a Self Pay Agreement.</div>"

  },
  "identifier": [
    {
      "system": "http://hospitalx.com/selfpayagreement",
      "value": "SP12345678"

  "identifier" : [{
    "system" : "http://hospitalx.com/selfpayagreement",
    "value" : "SP12345678"
  }],
  "status" : "active",
  "kind" : "self-pay",
  "paymentBy" : [{
    "party" : {
      "reference" : "Patient/5"

    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/coverage-selfpay",
        "code": "pay",
        "display": "PAY"
      }
    ]
  },
  "subscriber": {
    "reference": "Patient/5"

  }],
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/coverage-selfpay",
      "code" : "pay",
      "display" : "PAY"
    }]

  },
  "beneficiary": {
    "reference": "Patient/5"

  "subscriber" : {
    "reference" : "Patient/5"

  },
  "relationship": {
    "coding": [
      {
        "code": "self"
      }
    ]

  "beneficiary" : {
    "reference" : "Patient/5"

  },
  "period": {
    "end": "2012-03-17"

  "relationship" : {
    "coding" : [{
      "code" : "self"
    }]

  },
  "payor": [
    {
      "reference": "Patient/5"
    }
  ]

  "period" : {
    "end" : "2012-03-17"
  }

}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.