Release 4 R6 Ballot (1st Full Ballot)

This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU v6.0.0-ballot4: Release 6 Ballot (1st Full Ballot) (see Ballot Notes ) in it's permanent home (it will always be available at this URL). ). 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 for published versions R4

Coverageeligibilityrequest-example-2.xml

Example CoverageEligibilityRequest/52346 (XML)

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

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

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Primary Coverage specifying Benefit Example (id = "52346") 

<?xml version="1.0" encoding="UTF-8"?>

<CoverageEligibilityRequest xmlns="http://hl7.org/fhir">
  <id value="52346"/> 


  <text> 
    
    

    <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the CoverageEligibilityRequest</div> 
  </text> 


  <identifier> 
    <system value="http://happyvalley.com/coverageelegibilityrequest"/> 
    <value value="52346"/> 
  </identifier> 


  <status value="active"/> 


  <priority> 
    <coding> 
      <code value="normal"/> 
    </coding> 
  </priority> 


  <purpose value="validation"/> 
  <purpose value="benefits"/> 


  <patient> 
    

    <reference value="Patient/pat1"/> 
  </patient> 

  


  <servicedDate value="2014-09-17"/> 
  <!--   Anticipated service date   -->
  <created value="2014-08-16"/> 


  <enterer> 
    

    <identifier> 
      <system value="http://happyvalleyclinic.com/staff"/> 
      <value value="14"/> 
    

    </identifier> 
  </enterer> 


  <provider> 
    

    <reference value="Organization/1"/> 
  </provider> 


  <insurer> 
    

    <reference value="Organization/2"/> 
  </insurer> 


  <facility> 
    

    <identifier> 
      <system value="http://statecliniclicensor.com/clinicid"/> 
      <value value="G35B9"/> 
    

    </identifier> 
  </facility> 


  <insurance> 
    <coverage> 
      

      <reference value="Coverage/9876B1"/> 
    </coverage> 


    <businessArrangement value="NB8742"/> 
  </insurance> 


  <item> 
    <category> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/> 
        <code value="69"/> 
        <display value="Maternity"/> 
      </coding> 
    </category> 
  </item> 




</

CoverageEligibilityRequest

>

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.