Guía implementación interoperabilidad FHIR sectorial e intersectorial
0.10.1 - ci-build

Guía implementación interoperabilidad FHIR sectorial e intersectorial - Local Development build (v0.10.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: HCEU - Coverage

Defining URL:https://ohapi-fhir-service-fhir-project.apps.indraclusterdes.eastus.aroapp.io/StructureDefinition-ProfileCoverageHCEU
Version:0.10.1
Name:ProfileCoverageHCEU
Title:HCEU - Coverage
Status:Draft as of 2025-07-10 20:24:14-0500
Definition:

Recurso que permite registrar información del plan de salud que cubre al paciente ya sea por asegurador o de forma independiente

Publisher:minsait - An Indra Company. Secretaría de Salud de Bogotá,
Copyright:

Secretaría de Salud de Bogotá

Source Resource:XML / JSON / Turtle

La URL oficial para este perfil es: 

https://ohapi-fhir-service-fhir-project.apps.indraclusterdes.eastus.aroapp.io/StructureDefinition-ProfileCoverageHCEU

Vistas formales para el perfil

Descripción de perfiles, diferenciales, resumenes y cómo deben ser las representaciones en XML y JSON.

Esta estructura se deriva de Coverage

Esta estructura se deriva de Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage Coverage
... Slices for identifier S 1..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:use
.... identifier:HISdentifier 1..1 Identifier Business Identifier for the coverage
..... use 1..1 code usual | official | temp | secondary | old (If known)
Fixed Value: usual
..... type 0..0
..... system 1..1 uri The namespace for the identifier value
Example HIS uri: http://hospitalSystemInformation.example.org/Coverages/
..... value 1..1 string The value that is unique
..... period 0..0
..... assigner 0..0
... status 1..1 code active | cancelled | draft | entered-in-error
Fixed Value: active
... type S 0..1 CodeableConcept Coverage category such as medical or accident
... subscriber 0..1 Reference(HCEU - Patient | HCEU - Related Person) Subscriber to the policy
... beneficiary 1..1 Reference(HCEU - Patient) Plan beneficiary
... dependent 0..0
... payor 1..* Reference(HCEU - Organization | HCEU - Patient | HCEU - Related Person) Issuer of the policy
... class S 0..* BackboneElement Additional coverage classifications
... order 0..0
... network 0..0
... costToBeneficiary 0..0
... subrogation 0..0
... contract 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 1..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:use
.... identifier:HISdentifier Σ 1..1 Identifier Business Identifier for the coverage
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Fixed Value: usual
..... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
Example HIS uri: http://hospitalSystemInformation.example.org/Coverages/
..... value Σ 1..1 string The value that is unique
Example General: 123456
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
... policyHolder Σ 0..1 Reference(HCEU - Patient | HCEU - Related Person | HCEU - Organization) Owner of the policy
... subscriber Σ 0..1 Reference(HCEU - Patient | HCEU - Related Person) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(HCEU - Patient) Plan beneficiary
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(HCEU - Organization | HCEU - Patient | HCEU - Related Person) Issuer of the policy
... class S 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... identifier Σ 1..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:use
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
... class 0..* BackboneElement Additional coverage classifications

doco Documentation for this format

Esta estructura se deriva de Coverage

Vista de diferencias

Esta estructura se deriva de Coverage

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage Coverage
... Slices for identifier S 1..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:use
.... identifier:HISdentifier 1..1 Identifier Business Identifier for the coverage
..... use 1..1 code usual | official | temp | secondary | old (If known)
Fixed Value: usual
..... type 0..0
..... system 1..1 uri The namespace for the identifier value
Example HIS uri: http://hospitalSystemInformation.example.org/Coverages/
..... value 1..1 string The value that is unique
..... period 0..0
..... assigner 0..0
... status 1..1 code active | cancelled | draft | entered-in-error
Fixed Value: active
... type S 0..1 CodeableConcept Coverage category such as medical or accident
... subscriber 0..1 Reference(HCEU - Patient | HCEU - Related Person) Subscriber to the policy
... beneficiary 1..1 Reference(HCEU - Patient) Plan beneficiary
... dependent 0..0
... payor 1..* Reference(HCEU - Organization | HCEU - Patient | HCEU - Related Person) Issuer of the policy
... class S 0..* BackboneElement Additional coverage classifications
... order 0..0
... network 0..0
... costToBeneficiary 0..0
... subrogation 0..0
... contract 0..0

doco Documentation for this format

Tabla de resumen

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier SΣ 1..* Identifier Business Identifier for the coverage
Slice: Unordered, Open by pattern:use
.... identifier:HISdentifier Σ 1..1 Identifier Business Identifier for the coverage
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
Fixed Value: usual
..... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
Example HIS uri: http://hospitalSystemInformation.example.org/Coverages/
..... value Σ 1..1 string The value that is unique
Example General: 123456
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Fixed Value: active
... type SΣ 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
... policyHolder Σ 0..1 Reference(HCEU - Patient | HCEU - Related Person | HCEU - Organization) Owner of the policy
... subscriber Σ 0..1 Reference(HCEU - Patient | HCEU - Related Person) Subscriber to the policy
... subscriberId Σ 0..1 string ID assigned to the subscriber
... beneficiary Σ 1..1 Reference(HCEU - Patient) Plan beneficiary
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(HCEU - Organization | HCEU - Patient | HCEU - Related Person) Issuer of the policy
... class S 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value

doco Documentation for this format

 

Otras representaciones de este perfil: Schematron

Terminology Bindings

PathConformanceValueSet / CodeURI
Coverage.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
From the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.identifier:HISdentifier.userequiredFixed Value: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
From the FHIR Standard
Coverage.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
From the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
From the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
From the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
From the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
From the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()