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• Narrative Content
• XML
• JSON

: Coverage - Example ACH Monthly Pass1 - XML Representation

Page standards status: Informative

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="coverage-example-ach-monthly-pass1"/>
  <meta>
    <profile
             value="http://www.cy118119.com/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-monthly-coverage"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage coverage-example-ach-monthly-pass1</b></p><a name="coverage-example-ach-monthly-pass1"> </a><a name="hccoverage-example-ach-monthly-pass1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ach-monthly-coverage.html">ACH Monthly Event Coverage</a></p></div><p><b>identifier</b>: Member Number/084536836</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode SUBSIDIZ}">subsidized health program</span></p><p><b>policyHolder</b>: <a href="http://example.org/fhir/RelatedPerson/exampleMom">Mom Parent</a></p><p><b>subscriberId</b>: 98435938934</p><p><b>beneficiary</b>: <a href="Patient-patient-example-ach-monthly-pass1.html">Pass1 ACH(official) Female, DoB: 2024-02-01 ( MRN:?1601191901010308?(use:?usual,?))</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship child}">Child</span></p><p><b>period</b>: 2020-08-01 --&gt; (ongoing)</p><p><b>payor</b>: <a href="http://example.org/fhir/Organization/Medicaid">Medicaid</a></p></div>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
        <display value="Member Number"/>
      </coding>
    </type>
    <system value="http://example.org/fhir/memberidentifier"/>
    <value value="084536836"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="9.0.0"/>
      <code value="SUBSIDIZ"/>
      <display value="subsidized health program"/>
    </coding>
  </type>
  <policyHolder>
    <reference value="http://example.org/fhir/RelatedPerson/exampleMom"/>
    <display value="Mom Parent"/>
  </policyHolder>
  <subscriberId value="98435938934"/>
  <beneficiary>🔗 
    <reference value="Patient/patient-example-ach-monthly-pass1"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="child"/>
      <display value="Child"/>
    </coding>
    <text value="Child"/>
  </relationship>
  <period>
    <start value="2020-08-01"/>
  </period>
  <payor>
    <reference value="http://example.org/fhir/Organization/Medicaid"/>
    <display value="Medicaid"/>
  </payor>
</Coverage>