{
  "resourceType" : "Coverage",
  "id" : "coverage-example-ach-monthly-pass3",
  "meta" : {
    "profile" : ["http://www.cy118119.com/nhsn/fhirportal/dqm/ig/StructureDefinition/ach-monthly-coverage"]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage coverage-example-ach-monthly-pass3</b></p><a name=\"coverage-example-ach-monthly-pass3\"> </a><a name=\"hccoverage-example-ach-monthly-pass3\"> </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/0945345</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode PPO}\">preferred provider organization policy</span></p><p><b>subscriberId</b>: 7843574536</p><p><b>beneficiary</b>: <a href=\"Patient-patient-example-ach-monthly-pass3.html\">Pass3 ACH(official) Female, DoB: 2007-10-08 ( MRN:\u00a01601191903010308\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>payor</b>: <a href=\"http://example.org/fhir/Organization/NationFirst\">Nation First Health Care</a></p></div>"
  },
  "identifier" : [{
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code" : "MB",
        "display" : "Member Number"
      }]
    },
    "system" : "http://example.org/fhir/memberidentifier",
    "value" : "0945345"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
      "version" : "9.0.0",
      "code" : "PPO",
      "display" : "preferred provider organization policy"
    }]
  },
  "subscriberId" : "7843574536",
  "beneficiary" : {
    "reference" : "Patient/patient-example-ach-monthly-pass3"
  },
  "relationship" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
      "code" : "self",
      "display" : "Self"
    }]
  },
  "payor" : [{
    "reference" : "http://example.org/fhir/Organization/NationFirst",
    "display" : "Nation First Health Care"
  }]
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