FHIR Release 3 (STU) 5 Preview #3
This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 4.0.1 . For a full list of available versions, see the Directory of published versions

Coverage-example-selfpay.xml

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

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

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Self Payment Example (id = "SP1234")

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

<Coverage xmlns="http://hl7.org/fhir">
  <id value="SP1234"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of a Self Pay Agreement.</div> 
  </text> 
 
   
   
 
  
 
  
 
  
    
    
    
  
 

  <identifier> 
    <system value="http://hospitalx.com/selfpayagreement"/> 
    <value value="SP12345678"/> 
  </identifier> 
 
  
 
 
 
  
 
 
 
  
    
  
 

  <status value="active"/> 
  
   
 

  <type> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/> 
      <code value="pay"/> 
      <display value="PAY"/> 
    </coding> 
  </type> 
  <subscriber> 
    <reference value="Patient/5"/> 
  </subscriber> 
  <beneficiary> 
    <reference value="Patient/5"/> 
  </beneficiary> 
  <relationship> 
    <coding> 
      <code value="self"/> 
    </coding> 
  </relationship> 
  <period>  
    <end value="2012-03-17"/> 
  </period> 
  <payor> 
    <reference value="Patient/5"/> 
  </payor> 
 
  
 
 



</

Coverage

>



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.