FHIR Implementation Guide for ABDM - Local Development build (v3.0.0). See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: CoverageEligibilityResponse/benefit-example-01 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CoverageEligibilityResponse;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "benefit-example-01"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse";
       fhir:index 0;
       fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse>     ]
  ];
  fhir:Resource.language [ fhir:value "en"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p><b>Generated Narrative: CoverageEligibilityResponse</b><a name=\"benefit-example-01\"> </a></p><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\">Resource CoverageEligibilityResponse \"benefit-example-01\"  (Language \"en\") </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-CoverageEligibilityResponse.html\">CoverageEligibilityResponse</a></p></div><p><b>status</b>: active</p><p><b>purpose</b>: validation, benefits</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">Patient/example-01</a> \"\"</p><p><b>serviced</b>: 2023-08-07</p><p><b>created</b>: 2022-08-07</p><p><b>requestor</b>: <a href=\"Practitioner-example-01.html\">Practitioner/example-01</a> \"\"</p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-benefit-example-01.html\">CoverageEligibilityRequest/benefit-example-01</a></p><p><b>outcome</b>: queued</p><p><b>disposition</b>: Policy is currently in-force.</p><p><b>insurer</b>: <a href=\"Organization-example-01.html\">Organization/example-01</a> \"XYZ Lab Pvt.Ltd.\"</p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <a href=\"Coverage-example-01.html\">Coverage/example-01</a></p><p><b>inforce</b>: true</p><p><b>benefitPeriod</b>: 2022-05-07 --&gt; 2025-08-07</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: Removal of foreign body <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#10849003)</span></p><blockquote><p><b>benefit</b></p><p><b>type</b>: Benefit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#benefit)</span></p><p><b>allowed</b>: <span title=\"Indian Rupee\">₹150,000.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Copayment maximum per service <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#copay-maximum)</span></p><p><b>allowed</b>: <span title=\"Indian Rupee\">₹200,000.00</span> (INR)</p></blockquote><blockquote><p><b>benefit</b></p><p><b>type</b>: Copayment Percent per service <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-benefit-type.html\">Benefit Type Codes</a>#copay-percent)</span></p><p><b>allowed</b>: 20</p></blockquote></blockquote></blockquote></div>"
  ];
  fhir:CoverageEligibilityResponse.status [ fhir:value "active"];
  fhir:CoverageEligibilityResponse.purpose [
     fhir:value "validation";
     fhir:index 0
  ], [
     fhir:value "benefits";
     fhir:index 1
  ];
  fhir:CoverageEligibilityResponse.patient [
     fhir:Reference.reference [ fhir:value "Patient/example-01" ]
  ];
  fhir:CoverageEligibilityResponse.servicedDate [ fhir:value "2023-08-07"^^xsd:date];
  fhir:CoverageEligibilityResponse.created [ fhir:value "2022-08-07"^^xsd:date];
  fhir:CoverageEligibilityResponse.requestor [
     fhir:Reference.reference [ fhir:value "Practitioner/example-01" ]
  ];
  fhir:CoverageEligibilityResponse.request [
     fhir:Reference.reference [ fhir:value "CoverageEligibilityRequest/benefit-example-01" ]
  ];
  fhir:CoverageEligibilityResponse.outcome [ fhir:value "queued"];
  fhir:CoverageEligibilityResponse.disposition [ fhir:value "Policy is currently in-force."];
  fhir:CoverageEligibilityResponse.insurer [
     fhir:Reference.reference [ fhir:value "Organization/example-01" ]
  ];
  fhir:CoverageEligibilityResponse.insurance [
     fhir:index 0;
     fhir:Element.id [ fhir:value "21233" ];
     fhir:CoverageEligibilityResponse.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/example-01" ]     ];
     fhir:CoverageEligibilityResponse.insurance.inforce [ fhir:value "true"^^xsd:boolean ];
     fhir:CoverageEligibilityResponse.insurance.benefitPeriod [
       fhir:Period.start [ fhir:value "2022-05-07"^^xsd:date ];
       fhir:Period.end [ fhir:value "2025-08-07"^^xsd:date ]     ];
     fhir:CoverageEligibilityResponse.insurance.item [
       fhir:index 0;
       fhir:CoverageEligibilityResponse.insurance.item.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           a sct:10849003;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "10849003" ];
           fhir:Coding.display [ fhir:value "Removal of foreign body" ]         ]       ];
       fhir:CoverageEligibilityResponse.insurance.item.benefit [
         fhir:index 0;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-type" ];
             fhir:Coding.code [ fhir:value "benefit" ]           ]         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "150000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "INR" ]         ]       ], [
         fhir:index 1;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-type" ];
             fhir:Coding.code [ fhir:value "copay-maximum" ]           ]         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedMoney [
           fhir:Money.value [ fhir:value "200000"^^xsd:decimal ];
           fhir:Money.currency [ fhir:value "INR" ]         ]       ], [
         fhir:index 2;
         fhir:CoverageEligibilityResponse.insurance.item.benefit.type [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/benefit-type" ];
             fhir:Coding.code [ fhir:value "copay-percent" ]           ]         ];
         fhir:CoverageEligibilityResponse.insurance.item.benefit.allowedUnsignedInt [ fhir:value "20"^^xsd:nonNegativeInteger ]       ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.