FHIR Implementation Guide for ABDM
4.0.0 - active
FHIR Implementation Guide for ABDM
4.0.0 - active
FHIR Implementation Guide for ABDM - Local Development build (v4.0.0). See the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "ClaimResponseBundle-predeter-example-01",
"meta" : {
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponseBundle"
],
"security" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
"code" : "V",
"display" : "very restricted"
}
]
},
"identifier" : {
"system" : "http://hip.in",
"value" : "bc3c6c57-2053-4d0e-ac40-139ccccff645"
},
"type" : "collection",
"timestamp" : "2020-07-09T15:32:26.605+05:30",
"entry" : [
{
"fullUrl" : "ClaimResponse/ClaimResponse-predeter-example-01",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "ClaimResponse-predeter-example-01",
"meta" : {
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/ClaimResponse"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: ClaimResponse</b><a name=\"ClaimResponse-predeter-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 ClaimResponse "ClaimResponse-predeter-example-01" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ClaimResponse.html\">ClaimResponse</a></p></div><p><b>status</b>: active</p><p><b>type</b>: Management of health status after discharge from hospital (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#710967003)</span></p><p><b>subType</b>: Emergency Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-ex-claimsubtype.html\">Example Claim SubType Codes</a>#emergency)</span></p><p><b>use</b>: predetermination</p><p><b>patient</b>: <a href=\"#Patient_Patient-example-01\">See above (Patient/Patient-example-01)</a></p><p><b>created</b>: 2023-09-07 15:32:26+0530</p><p><b>insurer</b>: <a href=\"#Organization_Organization-example-01\">See above (Organization/Organization-example-01)</a></p><p><b>request</b>: <a href=\"#Claim_Claim-predeter-example-01\">See above (Claim/Claim-predeter-example-01)</a></p><p><b>outcome</b>: complete</p><p><b>payeeType</b>: Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-payeetype.html\">Payee Type Codes</a>#provider)</span></p><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: Consultant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#768839008)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>500.00</td><td>INR</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#255334000)</span></p><blockquote><p><b>amount</b></p><p><span title=\"Indian Rupee\">₹500.00</span> (INR)</p></blockquote></blockquote></blockquote><blockquote><p><b>addItem</b></p><p><b>itemSequence</b>: 2</p><p><b>productOrService</b>: Metformin hydrochloride 500 mg prolonged-release oral tablet <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#765507008)</span></p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>910.28</td><td>INR</td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: Eligible Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#eligible)</span></p><p><b>reason</b>: Covered <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#255334000)</span></p><blockquote><p><b>amount</b></p><p><span title=\"Indian Rupee\">₹910.28</span> (INR)</p></blockquote></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: Submitted Amount <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-adjudication.html\">Adjudication Value Codes</a>#submitted)</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>1410.28</td><td>INR</td></tr></table></blockquote><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"#Coverage_Coverage-example-01\">See above (Coverage/Coverage-example-01)</a></td></tr></table></div>"
},
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "710967003",
"display" : "Management of health status after discharge from hospital (procedure)"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
"code" : "emergency"
}
]
},
"use" : "predetermination",
"patient" : {
"reference" : "Patient/Patient-example-01"
},
"created" : "2023-09-07T15:32:26.605+05:30",
"insurer" : {
"reference" : "Organization/Organization-example-01"
},
"request" : {
"reference" : "Claim/Claim-predeter-example-01"
},
"outcome" : "complete",
"payeeType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
},
"addItem" : [
{
"itemSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "768839008",
"display" : "Consultant"
}
]
},
"net" : {
"value" : 500.00,
"currency" : "INR"
},
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible Amount"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "255334000",
"display" : "Covered"
}
]
},
"amount" : {
"value" : 500,
"currency" : "INR"
}
}
]
},
{
"itemSequence" : [
2
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "765507008",
"display" : "Metformin hydrochloride 500 mg prolonged-release oral tablet"
}
]
},
"net" : {
"value" : 910.28,
"currency" : "INR"
},
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible Amount"
}
]
},
"reason" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "255334000",
"display" : "Covered"
}
]
},
"amount" : {
"value" : 910.28,
"currency" : "INR"
}
}
]
}
],
"total" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "submitted"
}
]
},
"amount" : {
"value" : 1410.28,
"currency" : "INR"
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/Coverage-example-01"
}
}
]
}
},
{
"fullUrl" : "Patient/Patient-example-01",
"resource" : {
"resourceType" : "Patient",
"id" : "Patient-example-01",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2023-09-07T14:58:58.181+05:30",
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"Patient-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 Patient "Patient-example-01" Version "1" Updated "2023-09-07 14:58:58+0530" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Patient.html\">Patient</a></p></div><p><b>identifier</b>: Adhaar number: 7225-4829-5255</p><p><b>name</b>: Adarsh Agrawal</p><p><b>telecom</b>: <a href=\"tel:+919818512600\">+919818512600</a></p><p><b>gender</b>: male</p><p><b>birthDate</b>: 1981-01-12</p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ADN",
"display" : "Adhaar number"
}
]
},
"system" : "https://uidai.gov.in/",
"value" : "7225-4829-5255"
}
],
"name" : [
{
"text" : "Adarsh Agrawal"
}
],
"telecom" : [
{
"system" : "phone",
"value" : "+919818512600",
"use" : "home"
}
],
"gender" : "male",
"birthDate" : "1981-01-12"
}
},
{
"fullUrl" : "Organization/Organization-example-01",
"resource" : {
"resourceType" : "Organization",
"id" : "Organization-example-01",
"meta" : {
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"Organization-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 Organization "Organization-example-01" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Organization.html\">Organization</a></p></div><p><b>identifier</b>: Provider number: 4567878</p><p><b>type</b>: Insurance Company <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html\">Organization type</a>#ins)</span></p><p><b>name</b>: XYZ Insurance Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341234\">+91 243 2634 1234</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PRN",
"display" : "Provider number"
}
]
},
"system" : "https://facility.ndhm.gov.in",
"value" : "4567878"
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "ins",
"display" : "Insurance Company"
}
]
}
],
"name" : "XYZ Insurance Co. Ltd.",
"telecom" : [
{
"system" : "phone",
"value" : "+91 243 2634 1234",
"use" : "work"
},
{
"system" : "email",
"value" : "contact@xyz.org",
"use" : "work"
}
]
}
},
{
"fullUrl" : "Claim/Claim-predeter-example-01",
"resource" : {
"resourceType" : "Claim",
"id" : "Claim-predeter-example-01",
"meta" : {
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"Claim-predeter-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 Claim "Claim-predeter-example-01" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Claim.html\">Claim</a></p></div><p><b>identifier</b>: id:\u00a07612345</p><p><b>status</b>: active</p><p><b>type</b>: Management of health status after discharge from hospital (procedure) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#710967003)</span></p><p><b>subType</b>: Emergency Claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-ex-claimsubtype.html\">Example Claim SubType Codes</a>#emergency)</span></p><p><b>use</b>: predetermination</p><p><b>patient</b>: <a href=\"#Patient_Patient-example-01\">See above (Patient/Patient-example-01)</a></p><p><b>created</b>: 2023-09-07</p><p><b>insurer</b>: <a href=\"#Organization_Organization-example-01\">See above (Organization/Organization-example-01)</a></p><p><b>provider</b>: <a href=\"#Organization_Organization-example-01\">See above (Organization/Organization-example-01)</a></p><p><b>priority</b>: Immediate <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#stat)</span></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-payeetype.html\">Payee Type Codes</a>#provider)</span></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Type 2 diabetes mellitus : Without complications <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-icd10.html\">ICD-10</a>#E11.9)</span></td><td>Final diagnosis (discharge) (contextual qualifier) (qualifier value) <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#89100005)</span></td></tr></table><h3>Procedures</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Procedure[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Consultant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#768839008)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td><td><b>PreAuthRef</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"#Coverage_Coverage-example-01\">See above (Coverage/Coverage-example-01)</a></td><td>12S52</td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Consultant <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#768839008)</span></p><p><b>serviced</b>: 2023-09-07</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>500.00</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>500.00</td><td>INR</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>sequence</b>: 2</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: Metformin hydrochloride 500 mg prolonged-release oral tablet <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#765507008)</span></p><p><b>serviced</b>: 2023-09-07</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>910.28</td><td>INR</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>910.28</td><td>INR</td></tr></table></blockquote></div>"
},
"identifier" : [
{
"system" : "https://irdai.gov.in",
"value" : "7612345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "710967003",
"display" : "Management of health status after discharge from hospital (procedure)"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
"code" : "emergency",
"display" : "Emergency Claim"
}
]
},
"use" : "predetermination",
"patient" : {
"reference" : "Patient/Patient-example-01"
},
"created" : "2023-09-07",
"insurer" : {
"reference" : "Organization/Organization-example-01"
},
"provider" : {
"reference" : "Organization/Organization-example-01"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "stat",
"display" : "Immediate"
}
]
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider",
"display" : "Provider"
}
]
}
},
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10",
"code" : "E11.9",
"display" : "Type 2 diabetes mellitus : Without complications"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "89100005",
"display" : "Final diagnosis (discharge) (contextual qualifier) (qualifier value)"
}
]
}
]
}
],
"procedure" : [
{
"sequence" : 1,
"procedureCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "768839008",
"display" : "Consultant"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/Coverage-example-01"
},
"preAuthRef" : [
"12S52"
]
}
],
"item" : [
{
"sequence" : 1,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "768839008",
"display" : "Consultant"
}
]
},
"servicedDate" : "2023-09-07",
"unitPrice" : {
"value" : 500.00,
"currency" : "INR"
},
"net" : {
"value" : 500.00,
"currency" : "INR"
}
},
{
"sequence" : 2,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "765507008",
"display" : "Metformin hydrochloride 500 mg prolonged-release oral tablet"
}
]
},
"servicedDate" : "2023-09-07",
"unitPrice" : {
"value" : 910.28,
"currency" : "INR"
},
"net" : {
"value" : 910.28,
"currency" : "INR"
}
}
]
}
},
{
"fullUrl" : "Coverage/Coverage-example-01",
"resource" : {
"resourceType" : "Coverage",
"id" : "Coverage-example-01",
"meta" : {
"profile" : [
"https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"Coverage-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 Coverage "Coverage-example-01" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-Coverage.html\">Coverage</a></p></div><p><b>identifier</b>: id:\u00a0SP12345678</p><p><b>status</b>: active</p><p><b>type</b>: PAY <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-selfpay.html\">Coverage SelfPay Codes</a>#pay)</span></p><p><b>subscriber</b>: <a href=\"#Patient_Patient-example-01\">See above (Patient/Patient-example-01)</a></p><p><b>beneficiary</b>: <a href=\"#Patient_Patient-example-01\">See above (Patient/Patient-example-01)</a></p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: ?? --> 2026-03-17</p><p><b>payor</b>: <a href=\"#Organization_Organization-example-01\">See above (Organization/Organization-example-01)</a></p></div>"
},
"identifier" : [
{
"system" : "http://hospitalx.com/selfpayagreement",
"value" : "SP12345678"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-selfpay",
"code" : "pay",
"display" : "PAY"
}
]
},
"subscriber" : {
"reference" : "Patient/Patient-example-01"
},
"beneficiary" : {
"reference" : "Patient/Patient-example-01"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"end" : "2026-03-17"
},
"payor" : [
{
"reference" : "Organization/Organization-example-01"
}
]
}
}
]
}
IG © 2020+ National Resource Center for EHR Standards. Package ndhm.in#4.0.0 based on FHIR 4.0.1. Generated 2023-11-06
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