Release 4B R5 Final QA

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0-draft-final: Final QA Preview for R5 - STU see ballot notes ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

Coverage-example.ttl

Example Coverage/9876B1 (Turtle)

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

Raw Turtle (+ also see Turtle/RDF Format Specification )

General Person Primary Coverage Example 

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "9876B1"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  ];
  fhir:Coverage.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://benefitsinc.com/certificate" ];
     fhir:Identifier.value [ fhir:value "12345" ]
  ];
  fhir:Coverage.status [ fhir:value "active"];
  fhir:Coverage.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
       fhir:Coding.code [ fhir:value "EHCPOL" ];
       fhir:Coding.display [ fhir:value "extended healthcare" ]
     ]
  ];
  fhir:Coverage.policyHolder [
     fhir:link <http://benefitsinc.com/FHIR/Organization/CBI35>;
     fhir:Reference.reference [ fhir:value "http://benefitsinc.com/FHIR/Organization/CBI35" ]
  ];
  fhir:Coverage.subscriber [
     fhir:link <http://hl7.org/fhir/Patient/4>;
     fhir:Reference.reference [ fhir:value "Patient/4" ]
  ];
  fhir:Coverage.beneficiary [
     fhir:link <http://hl7.org/fhir/Patient/4>;
     fhir:Reference.reference [ fhir:value "Patient/4" ]
  ];
  fhir:Coverage.dependent [ fhir:value "0"];
  fhir:Coverage.relationship [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.code [ fhir:value "self" ]

[a fhir:Coverage ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "9876B1"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the coverage</div>"
  ] ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://benefitsinc.com/certificate"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "12345" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:kind [ fhir:v "insurance"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "EHCPOL" ] ;
       fhir:display [ fhir:v "extended healthcare" ]
     ] )
  ] ; # 
  fhir:policyHolder [
     fhir:link <http://benefitsinc.com/FHIR/Organization/CBI35> ;
     fhir:reference [ fhir:v "http://benefitsinc.com/FHIR/Organization/CBI35" ]
  ] ; # 
  fhir:subscriber [
     fhir:reference [ fhir:v "Patient/4" ]
  ] ; # 
  fhir:beneficiary [
     fhir:reference [ fhir:v "Patient/4" ]
  ] ; # 
  fhir:dependent [ fhir:v "0"] ; # 
  fhir:relationship [
     fhir:coding ( [
       fhir:code [ fhir:v "self" ]
     ] )
  ] ; # 
  fhir:period [
     fhir:start [ fhir:v "2011-05-23"^^xsd:date ] ;
     fhir:end [ fhir:v "2012-05-23"^^xsd:date ]
  ] ; # 
  fhir:insurer [
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  fhir:class ( [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "group" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "CB135" ]
     ] ;
     fhir:name [ fhir:v "Corporate Baker's Inc. Local #35" ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "subgroup" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "123" ]
     ] ;
     fhir:name [ fhir:v "Trainee Part-time Benefits" ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "plan" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "B37FC" ]
     ] ;
     fhir:name [ fhir:v "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC" ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "subplan" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "P7" ]
     ] ;
     fhir:name [ fhir:v "Includes afterlife benefits" ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "class" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "SILVER" ]
     ] ;
     fhir:name [ fhir:v "Silver: Family Plan spouse only" ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "subclass" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "Tier2" ]
     ] ;
     fhir:name [ fhir:v "Low deductable, max $20 copay" ]
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "sequence" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "9" ]

     ]
  ];
  fhir:Coverage.period [
     fhir:Period.start [ fhir:value "2011-05-23"^^xsd:date ];
     fhir:Period.end [ fhir:value "2012-05-23"^^xsd:date ]
  ];
  fhir:Coverage.payor [
     fhir:index 0;
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:Coverage.class [
     fhir:index 0;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "group" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "CB135" ];
     fhir:Coverage.class.name [ fhir:value "Corporate Baker's Inc. Local #35" ]
  ], [
     fhir:index 1;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "subgroup" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "123" ];
     fhir:Coverage.class.name [ fhir:value "Trainee Part-time Benefits" ]
  ], [
     fhir:index 2;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "plan" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "B37FC" ];
     fhir:Coverage.class.name [ fhir:value "Full Coverage: Medical, Dental, Pharmacy, Vision, EHC" ]
  ], [
     fhir:index 3;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "subplan" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "P7" ];
     fhir:Coverage.class.name [ fhir:value "Includes afterlife benefits" ]
  ], [
     fhir:index 4;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "class" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "SILVER" ];
     fhir:Coverage.class.name [ fhir:value "Silver: Family Plan spouse only" ]
  ], [
     fhir:index 5;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "subclass" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "Tier2" ];
     fhir:Coverage.class.name [ fhir:value "Low deductable, max $20 copay" ]
  ], [
     fhir:index 6;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "sequence" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "9" ]
  ], [
     fhir:index 7;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "rxid" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "MDF12345" ]
  ], [
     fhir:index 8;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "rxbin" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "987654" ]
  ], [
     fhir:index 9;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "rxgroup" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "M35PT" ]
  ], [
     fhir:index 10;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "rxpcn" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "234516" ]
  ], [
     fhir:index 11;
     fhir:Coverage.class.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
         fhir:Coding.code [ fhir:value "sequence" ]
       ]
     ];
     fhir:Coverage.class.value [ fhir:value "9" ]
  ] .

<http://hl7.org/fhir/Patient/4> a fhir:Patient .

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Coverage/9876B1.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/Coverage/9876B1.ttl> .

  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "rxid" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "MDF12345" ]
     ] #   member id used when submitting pharmacy claims  
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "rxbin" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "987654" ]
     ] #   the pharmacy processor BIN number used when submitting pharmacy claims  
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "rxgroup" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "M35PT" ]
     ] #   group used when submitting pharmacy claims  
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "rxpcn" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "234516" ]
     ] #   the PCN number used when submitting pharmacy claims  
  ] [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "sequence" ]
       ] )
     ] ;
     fhir:value [
       fhir:value [ fhir:v "9" ]
     ] #   the sequence number for a short-term continuance of the coverage  
  ] )] . #   The repeating 'class' element is proposed to replace the 'grouping' element  


# -------------------------------------------------------------------------------------

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.