HL7 FHIR JP Core ImplementationGuide
2.0.0-dev - ci-build Japan flag

HL7 FHIR JP Core ImplementationGuide - Local Development build (v2.0.0-dev) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: JP_Coverage - Detailed Descriptions

Active as of 2023-10-31

Definitions for the jp-coverage resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Coverage
Definition

Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
ヘルスケア製品およびサービスの償還または支払いに使用される可能性のある金融商品。 保険と自己負担の両方が含まれる。


Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.

ShortInsurance or medical plan or a payment agreement 保険または医療費支払いプラン、または合意された支払い方法
Comments

The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
Coverageには、保険証レベルの情報が含まれている。これは、保険金請求やプロバイダと保険会社間のその他の通信で提供するのが通例である。


The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If 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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Coverage.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Coverage.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 6. Coverage.extension:insuredPersonSymbol
    Slice NameinsuredPersonSymbol
    Definition

    健康保険における被保険者証記号を示す拡張

    Short健康保険における被保険者証記号
    Comments

    健康保険における被保険者証記号を示す拡張。被保険者記号の全角文字列。

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(JP Core Coverage InsuredPersonSymbol Extension) (Extension Type: string)
    Is Modifierfalse
    Must Supportfalse
    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    8. Coverage.extension:insuredPersonNumber
    Slice NameinsuredPersonNumber
    Definition

    健康保険における被保険者証番号を示す拡張

    Short健康保険における被保険者証番号
    Comments

    健康保険における被保険者証番号を示す拡張。被保険者記号の全角文字列。

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(JP Core Coverage InsuredPersonNumber Extension) (Extension Type: string)
    Is Modifierfalse
    Must Supportfalse
    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. Coverage.extension:insuredPersonSubNumber
    Slice NameinsuredPersonSubNumber
    Definition

    健康保険における被保険者証番号の枝番を示す拡張

    Short健康保険における被保険者証番号の枝番
    Comments

    健康保険における被保険者証番号を示す拡張。2桁の全角数字文字列。一桁の場合には先頭に0をつけて2桁にする。

    Control0..*
    This element is affected by the following invariants: ele-1
    TypeExtension(JP Core Coverage InsuredPersonSubNumber Extension) (Extension Type: string)
    Is Modifierfalse
    Must Supportfalse
    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. Coverage.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Must Supportfalse
    Summaryfalse
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. Coverage.identifier
    Definition

    A unique identifier assigned to this coverage.
    このカバレッジに割り当てられた一意の識別子。


    A unique identifier assigned to this coverage.

    ShortBusiness Identifier for the coverage このカバレッジに割り当てられた一意の識別子【詳細参照】
    Comments

    The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependent.
    カバレッジのメイン(および場合によっては唯一の)識別子-多くの場合、メンバID、証明書番号、個人の健康番号、またはケースIDと呼ばれる。
    【JP Core仕様】被保険者記号と番号と枝番を全角にした上でダブルコーテーションで囲い、カンマ区切りで連結する。
    ルール:"{被保険者記号}","{被保険者番号}","{枝番}"
    例:"12-34","5678","00"


    The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..*
    TypeIdentifier
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Allows coverages to be distinguished and referenced.
    カバレッジを区別して参照できるようにする。


    Allows coverages to be distinguished and referenced.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. Coverage.status
    Definition

    The status of the resource instance.
    リソースインスタンスのステータス。


    The status of the resource instance.

    Shortactive | cancelled | draft | entered-in-error
    Comments

    This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
    ステータスには、カバレッジが現在無効であることを示すエラー入力されたコードが含まれているため、この要素は修飾子としてラベル付けされる。


    This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.

    Control1..1
    BindingThe codes SHALL be taken from FinancialResourceStatusCodeshttp://hl7.org/fhir/ValueSet/fm-status|4.3.0
    (required to http://hl7.org/fhir/ValueSet/fm-status|4.3.0)

    A code specifying the state of the resource instance.

    Typecode
    Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
    「ドラフト」リソースはさらに編集される可能性があり、「アクティブ」リソースは不変であり、ステータスが「キャンセル」に変更されるだけである可能性があるため、リソースのステータスを追跡する必要がある。


    Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. Coverage.type
    Definition

    The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
    補償の種類:社会プログラム、医療計画、事故補償(労働者災害補償、自動車)、グループの健康、または個人または組織による支払い。


    The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.

    ShortCoverage category such as medical or accident 医療保険や事故補償のような分類
    Comments

    Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
    すべてのターミノロジの使用がこの一般的なパターンに適合するわけではない。場合によっては、モデルはCodeableConceptを使用せず、コーディングを直接使用して、テキスト、コーディング、翻訳、および要素間の関係とpre-coordinationとpost-coordinationの用語関係を管理するための独自の構造を提供する必要がある。
    【JP Core仕様】「処方情報 HL7FHIR 記述仕様」等で使用される保険種別コード(system=”urn:oid:1.2.392.100495.20.2.61”)として、https://www.mhlw.go.jp/content/10800000/000342368.pdf の別表11が使用している例があげられている。JP Coreとして本項目に対する用語のバインドは現時点では定義するまでに至っていない。

    Control0..1
    BindingThe codes SHOULD be taken from CoverageTypeAndSelf-PayCodeshttp://hl7.org/fhir/ValueSet/coverage-type
    (preferred to http://hl7.org/fhir/ValueSet/coverage-type)

    The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    The order of application of coverages is dependent on the types of coverage.
    カバレッジの適用順序は、カバレッジのタイプによって異なる。


    The order of application of coverages is dependent on the types of coverage.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. Coverage.policyHolder
    Definition

    The party who 'owns' the insurance policy.
    保険証券を「所有する」当事者。


    The party who 'owns' the insurance policy.

    ShortOwner of the policy ポリシの所有者
    Comments

    For example: may be an individual, corporation or the subscriber's employer.
    例:個人、企業、または加入者の雇用主である可能性がある。


    For example: may be an individual, corporation or the subscriber's employer.

    Control0..1
    TypeReference(JP Core Patient Profile, RelatedPerson, JP Core Organization Profile, Patient, Organization)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    This provides employer information in the case of Worker's Compensation and other policies.
    これは、労働者災害補償およびその他のポリシの場合に雇用者情報を提供する。


    This provides employer information in the case of Worker's Compensation and other policies.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. Coverage.subscriber
    Definition

    The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.
    ポリシにサインアップした、またはポリシとの契約関係を「所有」している当事者、またはポリシの利益が彼らまたはその家族に提供されることになっている当事者。


    The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.

    ShortSubscriber to the policy 被保険者
    Comments

    May be self or a parent in the case of dependents.
    扶養家族の場合、自己または親である可能性がある。


    May be self or a parent in the case of dependants.

    Control0..1
    TypeReference(JP Core Patient Profile, RelatedPerson, Patient)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    This is the party who is entitled to the benefits under the policy.
    これは、ポリシに基づいて給付を受ける権利を有する当事者である。


    This is the party who is entitled to the benfits under the policy.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    24. Coverage.subscriberId
    Definition

    The insurer assigned ID for the Subscriber.
    被保険者に保険者が割り当てたID


    The insurer assigned ID for the Subscriber.

    ShortID assigned to the subscriber 被保険者に割り当てられたID
    Control0..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    The insurer requires this identifier on correspondence and claims (digital and otherwise).
    保険者は、連絡や請求(デジタルおよびその他)でこの識別子を要求する。
    保険会社は、通信および請求(デジタルおよびその他)でこの識別子を要求する。
    【JP Core仕様】被保険者記号と番号を全角にした上でダブルコーテーションで囲い、カンマ区切りで連結する。
    ルール:"{被保険者記号}","{被保険者番号}"
    例:"12-34","5678"


    The insurer requires this identifier on correspondance and claims (digital and otherwise).

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. Coverage.beneficiary
    Definition

    The party who benefits from the insurance coverage; the patient when products and/or services are provided.
    保険適用から利益を得る当事者、製品および/またはサービスが提供される際の患者。


    The party who benefits from the insurance coverage; the patient when products and/or services are provided.

    ShortPlan beneficiary
    Comments

    References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
    参照は、実際のFHIRリソースへの参照である必要があり、解決可能(内容に到達可能)である必要がある(アクセス制御、一時的な使用不可などを考慮に入れる)。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。
    【JP Core仕様】患者Patientリソースへの参照。

    Control1..1
    TypeReference(JP Core Patient Profile, Patient)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    This is the party who receives treatment for which the costs are reimbursed under the coverage.
    これは、補償の下で費用が償還される治療を受ける側のことである。


    This is the party who receives treatment for which the costs are reimbursed under the coverage.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. Coverage.dependent
    Definition

    A unique identifier for a dependent under the coverage.
    被保険者証の枝番。


    A unique identifier for a dependent under the coverage.

    Short被保険者証 枝番Dependent number
    Comments

    Periodically the member number is constructed from the subscriberId and the dependent number.
    被保険者証の枝番を全角で格納する。


    Periodically the member number is constructed from the subscriberId and the dependant number.

    Control0..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.
    一部の補償では、単一の識別子が加入者に発行され、次に一意の従属番号が各受益者に発行される。
    一部の保険では、単一の識別子が加入者に発行され、その後、各受益者に固有の扶養番号が発行される。
    【JP Core仕様】医療保険で本リソースを使用する場合には、この要素に拡張 InsuredPersonSubNumberに設定した値と同じ、被保険者番号の枝番号全角2桁を設定する。
    例:"00"


    For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. Coverage.relationship
    Definition

    The relationship of beneficiary (patient) to the subscriber.
    受益者(患者)と加入者の関係。


    The relationship of beneficiary (patient) to the subscriber.

    ShortBeneficiary relationship to the subscriber 加入者との受益者関係
    Comments

    Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.
    一般的に、個人は、他人が所有するポリシよりも、自分のポリシ(relationship='self')を使用する。


    Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.

    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from SubscriberRelationshipCodeshttp://hl7.org/fhir/ValueSet/subscriber-relationship
    (extensible to http://hl7.org/fhir/ValueSet/subscriber-relationship)

    The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Requirements

    To determine relationship between the patient and the subscriber to determine coordination of benefits.
    患者と加入者の関係を決定し、給付の調整を決定する。
    【JP Core仕様】「処方情報 HL7FHIR 記述仕様」等で使用される被保険者区分コード(system=”urn:oid:1.2.392.100495.20.2.62”)として、https://www.mhlw.go.jp/content/10800000/000342368.pdf の別表12が使用できる。
     1 被保険者
     2 被扶養者


    To determine relationship between the patient and the subscriber to determine coordination of benefits.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. Coverage.period
    Definition

    Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
    補償範囲が有効である期間。開始日が欠落している場合は、開始日が不明であることを示す。終了日が欠落している場合は、補償範囲が引き続き有効であることを意味する。


    Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.

    ShortCoverage start and end dates
    Comments

    A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
    Period(期間)は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、範囲から1つの値が適用されるか(たとえば、「この2回の間に患者に投与する」)を指定する。
    Period(期間)は、Duration(時間区間=経過時間の測定値)には使用されない。 [Duration](datatypes.html#Duration)を参照のこと。
    This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
    これはDuration(時間区間)ではない- Durationは時間の尺度(別のタイプ)だが、時間の固定値で発生する時間区間である。Period(期間)は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、範囲から1つの値が適用されるか(たとえば、「この2回の間に患者に投与する」)を指定する。もし、Duration(時間区間)が必要な場合は、タイプをInterval | Durationとして指定する。
    これは期間ではなく-これは時間の尺度(別のタイプ)あるが、時間の固定値で発生する期間である。期間は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、または範囲から1つの値が適用されるか(たとえば、「これら2回の間に患者に与える」)を指定する。期間が必要な場合は、タイプをInterval | Durationとして指定する。
    【JP Core仕様】医療保険、公費で本リソースを使用する場合には、保険証または公費の有効期間の開始日、終了日をstart とendに yyyy-mm-dd形式で設定する。

    Control0..1
    TypePeriod
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Some insurers require the submission of the coverage term.
    保険会社によっては、補償期間の提出を義務付けているところもある。


    Some insurers require the submission of the coverage term.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. Coverage.payor
    Definition

    The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
    患者負担契約などの保険契約と保険外契約の両方を含むプログラムまたはプランの引受人または支払人。


    The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.

    ShortIssuer of the policy
    Comments

    May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.
    保険会社の識別子や事業者の識別子(BIN番号)など、複数の識別子を提供してもよい。自己負担の場合は、複数の支払者および/または組織を提供してもよい。


    May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.

    Control1..*
    TypeReference(JP Core Organization Profile, JP Core Patient Profile, RelatedPerson, Organization, Patient)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Need to identify the issuer to target for claim processing and for coordination of benefit processing.
    請求処理および給付処理の調整の対象となる発行者を特定する必要がある。
    【JP Core仕様】医療保険で本リソースを使用する場合には、保険者組織Organizationリソースへの参照。自費の場合には、患者Patientリソースへの参照。公費の場合には、公費負担者組織Organizationリソースへの参照。


    Need to identify the issuer to target for claim processing and for coordination of benefit processing.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    36. Coverage.class
    Definition

    A suite of underwriter specific classifiers.
    保険事業者の分類子


    A suite of underwriter specific classifiers.

    ShortAdditional coverage classifications
    Comments

    For example may be used to identify a class of coverage or employer group, Policy, Plan.
    例えば、保険の種類または雇用者グループ、保険契約、Planを識別するために使用することができる。


    For example may be used to identify a class of coverage or employer group, Policy, Plan.

    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Requirements

    The codes provided on the health card which identify or confirm the specific policy for the insurer.
    健康カードに記載されているコードで、保険者の特定の保険契約を識別または確認するもの。


    The codes provided on the health card which identify or confirm the specific policy for the insurer.

    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    38. Coverage.class.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    40. Coverage.class.type
    Definition

    The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
    保険者固有のクラスラベルまたは番号、任意の名前が提供されている分類のタイプを表す。例えば、保険のクラスまたは雇用者グループ、保険契約、Planを識別するために使用することができる。


    The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.

    ShortType of class such as 'group' or 'plan'
    Comments

    Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
    すべての用語の使用がこの一般的なパターンに適合するわけではない。いくつかのケースでは、モデルはCodeableConceptを使用せず、Codingを直接使用し、テキスト、コーディング、翻訳、要素間の関係、および前後の調整を管理するための独自の構造を提供することが望ましい。

    Control1..1
    BindingUnless not suitable, these codes SHALL be taken from CoverageClassCodeshttp://hl7.org/fhir/ValueSet/coverage-class
    (extensible to http://hl7.org/fhir/ValueSet/coverage-class)

    The policy classifications, eg. Group, Plan, Class, etc.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    The insurer issued label for a specific health card value.
    保険者が発行した特定の健康カード番号のラベル。


    The insurer issued label for a specific health card value.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    42. Coverage.class.value
    Definition

    The alphanumeric string value associated with the insurer issued label.
    保険者が発行したラベルに関連付けられた英数字の文字列値。


    The alphanumeric string value associated with the insurer issued label.

    ShortValue associated with the type
    Comments

    For example, the Group or Plan number.
    例えば、グループ番号やプラン番号など。


    For example, the Group or Plan number.

    Control1..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    The insurer issued label and value are necessary to identify the specific policy.
    保険者が発行したラベルと値は、特定の保険契約を識別するために必要なものである。


    The insurer issued label and value are necessary to identify the specific policy.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. Coverage.class.name
    Definition

    A short description for the class.
    保険種類の簡単な説明。


    A short description for the class.

    ShortHuman readable description of the type and value
    Control0..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Used to provide a meaningful description in correspondence to the patient.
    患者に対応するのに意味のある説明をするために使用する。


    Used to provide a meaningful description in correspondence to the patient.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    46. Coverage.order
    Definition

    The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
    現在適用されている他の保障と比較して、この保障の適用可能性が高い順に記載されている。なお、ナンバリングにギャップがある場合があり、カバーの具体的な位置づけはケアのエピソードに依存するため、一次、二次などを意味するものではない。


    The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.

    ShortRelative order of the coverage
    Comments

    32 bit number; for values larger than this, use decimal
    32 ビットの数値、これより大きい値の場合は 10 進数を使用する。

    Control0..1
    TypepositiveInt
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Used in managing the coordination of benefits.
    保険給付の調整管理に使用する。
    【JP Core仕様】公費情報で本リソースを使用する場合で、複数の公費負担情報がある場合に、その適用順序番号を示す1,2,3...を設定する。


    Used in managing the coordination of benefits.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. Coverage.network
    Definition

    The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
    保険者が定義したプロバイダの保険者定義ネットワークの保険者固有の識別子で、被保険者が「ネットワーク内」の料金でカバーされる治療を受けることができるが、そうでなければ「ネットワーク外」の条件が適用される。


    The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.

    ShortInsurer network
    Control0..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Used in referral for treatment and in claims processing.
    治療のための紹介や請求処理の際に使用する。


    Used in referral for treatment and in claims processing.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. Coverage.costToBeneficiary
    Definition

    A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
    ポリシに詳細が記載されており、ヘルスカードに含まれている可能性のあるコストカテゴリと関連する金額を示す一連のコード。


    A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.

    ShortPatient payments for services/products サービスやプロダクトに対する患者支払い
    Comments

    For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
    例えば、患者の訪問時の自己負担額を知ることで、医療提供者は治療を行う前にその金額を回収することができる。
    【JP Core仕様】公費の場合には自己負担率。判明している場合のみ設定する。


    For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.

    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Requirements

    Required by providers to manage financial transaction with the patient.
    事業者が患者との金銭的な取引を管理するために必要となる。


    Required by providers to manage financial transaction with the patient.

    Alternate NamesCoPay, Deductible, Exceptions
    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    52. Coverage.costToBeneficiary.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    54. Coverage.costToBeneficiary.type
    Definition

    The category of patient centric costs associated with treatment.
    治療に伴う患者中心の費用のカテゴリー。


    The category of patient centric costs associated with treatment.

    ShortCost category
    Comments

    For example visit, specialist visits, emergency, inpatient care, etc.
    例えば、訪問診療、専門医の訪問診療、救急診療、入院診療など。


    For example visit, specialist visits, emergency, inpatient care, etc.

    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from CoverageCopayTypeCodeshttp://hl7.org/fhir/ValueSet/coverage-copay-type
    (extensible to http://hl7.org/fhir/ValueSet/coverage-copay-type)

    The types of services to which patient copayments are specified.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Needed to identify the category associated with the amount for the patient.
    患者の金額に関連するカテゴリーを特定する必要があった。


    Needed to identify the category associated with the amount for the patient.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    56. Coverage.costToBeneficiary.value[x]
    Definition

    The amount due from the patient for the cost category.
    費用区分の患者からの支払額。


    The amount due from the patient for the cost category.

    ShortThe amount or percentage due from the beneficiary
    Comments

    Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.
    金額は、サービス/製品のコストに対する割合で表現される場合と、通貨の固定額で表現される場合がある。


    Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.

    Control1..1
    TypeChoice of: Quantity(SimpleQuantity), Money
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Needed to identify the amount for the patient associated with the category.
    カテゴリーに関連する患者の支払い金額を特定する必要があった


    Needed to identify the amount for the patient associated with the category.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    58. Coverage.costToBeneficiary.exception
    Definition

    A suite of codes indicating exceptions or reductions to patient costs and their effective periods.
    患者費用の例外または削減を示すコードとその有効期間を示すコード群。


    A suite of codes indicating exceptions or reductions to patient costs and their effective periods.

    ShortExceptions for patient payments
    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Requirements

    Required by providers to manage financial transaction with the patient.
    事業者が患者との金銭的な取引を管理するために必要となる。


    Required by providers to manage financial transaction with the patient.

    Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
    60. Coverage.costToBeneficiary.exception.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored even if unrecognized
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
    Summarytrue
    Requirements

    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

    Alternate Namesextensions, user content, modifiers
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    62. Coverage.costToBeneficiary.exception.type
    Definition

    The code for the specific exception.
    特定の例外のコード。


    The code for the specific exception.

    ShortException category
    Control1..1
    BindingFor example codes, see ExampleCoverageFinancialExceptionCodeshttp://hl7.org/fhir/ValueSet/coverage-financial-exception
    (example to http://hl7.org/fhir/ValueSet/coverage-financial-exception)

    The types of exceptions from the part or full value of financial obligations such as copays.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Needed to identify the exception associated with the amount for the patient.
    患者の金額に関連する例外を特定する必要があった。


    Needed to identify the exception associated with the amount for the patient.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    64. Coverage.costToBeneficiary.exception.period
    Definition

    The timeframe during when the exception is in force.
    例外が発生している間の時間枠。


    The timeframe during when the exception is in force.

    ShortThe effective period of the exception
    Control0..1
    TypePeriod
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
    患者の費用を正しく計算するための例外の適用時期を特定する必要があった。


    Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    66. Coverage.subrogation
    Definition

    When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
    subrogation=trueの場合、この保険インスタンスは裁定のためではなく、保険者に費用回収のための詳細を提供するために含まれている。 (subrogation=代位、subrogation payment=代位納付)


    When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.

    ShortReimbursement to insurer 保険者への償還
    Comments

    Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
    一般的に、自動車保険や労災保険では、医療費支払い者が事故請求に対して回収できるように、subrogation=true というフラグが立てられている。


    Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.

    Control0..1
    Typeboolean
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summaryfalse
    Requirements

    See definition for when to be used.
    使用時期については定義を参照すること。


    See definition for when to be used.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    68. Coverage.contract
    Definition

    The policy(s) which constitute this insurance coverage.
    この保険の適用範囲を構成するポリシ。


    The policy(s) which constitute this insurance coverage.

    ShortContract details 契約の詳細
    Comments

    References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
    参照は、実際のFHIRリソースへの参照である必要があり、解決可能(内容に到達可能)である必要がある(アクセス制御、一時的な使用不可などを考慮に入れる)。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。

    Control0..*
    TypeReference(Contract)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Requirements

    To reference the legally binding contract between the policy holder and the insurer.
    契約者と保険者との間の法的拘束力のある契約を参照するため。


    To reference the legally binding contract between the policy holder and the insurer.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

    Guidance on how to interpret the contents of this table can be found here

    0. Coverage
    Definition

    Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
    ヘルスケア製品およびサービスの償還または支払いに使用される可能性のある金融商品。 保険と自己負担の両方が含まれる。

    ShortInsurance or medical plan or a payment agreement 保険または医療費支払いプラン、または合意された支払い方法
    Comments

    The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
    Coverageには、保険証レベルの情報が含まれている。これは、保険金請求やプロバイダと保険会社間のその他の通信で提供するのが通例である。

    2. Coverage.extension
    SlicingThis element introduces a set of slices on Coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 4. Coverage.extension:insuredPersonSymbol
      Slice NameinsuredPersonSymbol
      Control0..*
      TypeExtension(JP Core Coverage InsuredPersonSymbol Extension) (Extension Type: string)
      6. Coverage.extension:insuredPersonNumber
      Slice NameinsuredPersonNumber
      Control0..*
      TypeExtension(JP Core Coverage InsuredPersonNumber Extension) (Extension Type: string)
      8. Coverage.extension:insuredPersonSubNumber
      Slice NameinsuredPersonSubNumber
      Control0..*
      TypeExtension(JP Core Coverage InsuredPersonSubNumber Extension) (Extension Type: string)
      10. Coverage.identifier
      Definition

      A unique identifier assigned to this coverage.
      このカバレッジに割り当てられた一意の識別子。

      ShortBusiness Identifier for the coverage このカバレッジに割り当てられた一意の識別子【詳細参照】
      Comments

      The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependent.
      カバレッジのメイン(および場合によっては唯一の)識別子-多くの場合、メンバID、証明書番号、個人の健康番号、またはケースIDと呼ばれる。
      【JP Core仕様】被保険者記号と番号と枝番を全角にした上でダブルコーテーションで囲い、カンマ区切りで連結する。
      ルール:"{被保険者記号}","{被保険者番号}","{枝番}"
      例:"12-34","5678","00"

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Requirements

      Allows coverages to be distinguished and referenced.
      カバレッジを区別して参照できるようにする。

      12. Coverage.status
      Definition

      The status of the resource instance.
      リソースインスタンスのステータス。

      Comments

      This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
      ステータスには、カバレッジが現在無効であることを示すエラー入力されたコードが含まれているため、この要素は修飾子としてラベル付けされる。

      Requirements

      Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
      「ドラフト」リソースはさらに編集される可能性があり、「アクティブ」リソースは不変であり、ステータスが「キャンセル」に変更されるだけである可能性があるため、リソースのステータスを追跡する必要がある。

      14. Coverage.type
      Definition

      The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
      補償の種類:社会プログラム、医療計画、事故補償(労働者災害補償、自動車)、グループの健康、または個人または組織による支払い。

      ShortCoverage category such as medical or accident 医療保険や事故補償のような分類
      Comments

      Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
      すべてのターミノロジの使用がこの一般的なパターンに適合するわけではない。場合によっては、モデルはCodeableConceptを使用せず、コーディングを直接使用して、テキスト、コーディング、翻訳、および要素間の関係とpre-coordinationとpost-coordinationの用語関係を管理するための独自の構造を提供する必要がある。
      【JP Core仕様】「処方情報 HL7FHIR 記述仕様」等で使用される保険種別コード(system=”urn:oid:1.2.392.100495.20.2.61”)として、https://www.mhlw.go.jp/content/10800000/000342368.pdf の別表11が使用している例があげられている。JP Coreとして本項目に対する用語のバインドは現時点では定義するまでに至っていない。

      Requirements

      The order of application of coverages is dependent on the types of coverage.
      カバレッジの適用順序は、カバレッジのタイプによって異なる。

      16. Coverage.policyHolder
      Definition

      The party who 'owns' the insurance policy.
      保険証券を「所有する」当事者。

      ShortOwner of the policy ポリシの所有者
      Comments

      For example: may be an individual, corporation or the subscriber's employer.
      例:個人、企業、または加入者の雇用主である可能性がある。

      TypeReference(JP Core Patient Profile, RelatedPerson, JP Core Organization Profile)
      Requirements

      This provides employer information in the case of Worker's Compensation and other policies.
      これは、労働者災害補償およびその他のポリシの場合に雇用者情報を提供する。

      18. Coverage.subscriber
      Definition

      The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.
      ポリシにサインアップした、またはポリシとの契約関係を「所有」している当事者、またはポリシの利益が彼らまたはその家族に提供されることになっている当事者。

      ShortSubscriber to the policy 被保険者
      Comments

      May be self or a parent in the case of dependents.
      扶養家族の場合、自己または親である可能性がある。

      TypeReference(JP Core Patient Profile, RelatedPerson)
      Requirements

      This is the party who is entitled to the benefits under the policy.
      これは、ポリシに基づいて給付を受ける権利を有する当事者である。

      20. Coverage.subscriberId
      Definition

      The insurer assigned ID for the Subscriber.
      被保険者に保険者が割り当てたID

      ShortID assigned to the subscriber 被保険者に割り当てられたID
      Requirements

      The insurer requires this identifier on correspondence and claims (digital and otherwise).
      保険者は、連絡や請求(デジタルおよびその他)でこの識別子を要求する。
      保険会社は、通信および請求(デジタルおよびその他)でこの識別子を要求する。
      【JP Core仕様】被保険者記号と番号を全角にした上でダブルコーテーションで囲い、カンマ区切りで連結する。
      ルール:"{被保険者記号}","{被保険者番号}"
      例:"12-34","5678"

      22. Coverage.beneficiary
      Definition

      The party who benefits from the insurance coverage; the patient when products and/or services are provided.
      保険適用から利益を得る当事者、製品および/またはサービスが提供される際の患者。

      Comments

      References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
      参照は、実際のFHIRリソースへの参照である必要があり、解決可能(内容に到達可能)である必要がある(アクセス制御、一時的な使用不可などを考慮に入れる)。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。
      【JP Core仕様】患者Patientリソースへの参照。

      TypeReference(JP Core Patient Profile)
      Requirements

      This is the party who receives treatment for which the costs are reimbursed under the coverage.
      これは、補償の下で費用が償還される治療を受ける側のことである。

      24. Coverage.dependent
      Definition

      A unique identifier for a dependent under the coverage.
      被保険者証の枝番。

      Short被保険者証 枝番
      Comments

      Periodically the member number is constructed from the subscriberId and the dependent number.
      被保険者証の枝番を全角で格納する。

      Requirements

      For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.
      一部の補償では、単一の識別子が加入者に発行され、次に一意の従属番号が各受益者に発行される。
      一部の保険では、単一の識別子が加入者に発行され、その後、各受益者に固有の扶養番号が発行される。
      【JP Core仕様】医療保険で本リソースを使用する場合には、この要素に拡張 InsuredPersonSubNumberに設定した値と同じ、被保険者番号の枝番号全角2桁を設定する。
      例:"00"

      26. Coverage.relationship
      Definition

      The relationship of beneficiary (patient) to the subscriber.
      受益者(患者)と加入者の関係。

      ShortBeneficiary relationship to the subscriber 加入者との受益者関係
      Comments

      Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.
      一般的に、個人は、他人が所有するポリシよりも、自分のポリシ(relationship='self')を使用する。

      Requirements

      To determine relationship between the patient and the subscriber to determine coordination of benefits.
      患者と加入者の関係を決定し、給付の調整を決定する。
      【JP Core仕様】「処方情報 HL7FHIR 記述仕様」等で使用される被保険者区分コード(system=”urn:oid:1.2.392.100495.20.2.62”)として、https://www.mhlw.go.jp/content/10800000/000342368.pdf の別表12が使用できる。
       1 被保険者
       2 被扶養者

      28. Coverage.period
      Definition

      Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
      補償範囲が有効である期間。開始日が欠落している場合は、開始日が不明であることを示す。終了日が欠落している場合は、補償範囲が引き続き有効であることを意味する。

      Comments

      A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
      Period(期間)は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、範囲から1つの値が適用されるか(たとえば、「この2回の間に患者に投与する」)を指定する。
      Period(期間)は、Duration(時間区間=経過時間の測定値)には使用されない。 [Duration](datatypes.html#Duration)を参照のこと。
      This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
      これはDuration(時間区間)ではない- Durationは時間の尺度(別のタイプ)だが、時間の固定値で発生する時間区間である。Period(期間)は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、範囲から1つの値が適用されるか(たとえば、「この2回の間に患者に投与する」)を指定する。もし、Duration(時間区間)が必要な場合は、タイプをInterval | Durationとして指定する。
      これは期間ではなく-これは時間の尺度(別のタイプ)あるが、時間の固定値で発生する期間である。期間は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、または範囲から1つの値が適用されるか(たとえば、「これら2回の間に患者に与える」)を指定する。期間が必要な場合は、タイプをInterval | Durationとして指定する。
      【JP Core仕様】医療保険、公費で本リソースを使用する場合には、保険証または公費の有効期間の開始日、終了日をstart とendに yyyy-mm-dd形式で設定する。

      Requirements

      Some insurers require the submission of the coverage term.
      保険会社によっては、補償期間の提出を義務付けているところもある。

      30. Coverage.payor
      Definition

      The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
      患者負担契約などの保険契約と保険外契約の両方を含むプログラムまたはプランの引受人または支払人。

      Comments

      May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.
      保険会社の識別子や事業者の識別子(BIN番号)など、複数の識別子を提供してもよい。自己負担の場合は、複数の支払者および/または組織を提供してもよい。

      TypeReference(JP Core Organization Profile, JP Core Patient Profile, RelatedPerson)
      Requirements

      Need to identify the issuer to target for claim processing and for coordination of benefit processing.
      請求処理および給付処理の調整の対象となる発行者を特定する必要がある。
      【JP Core仕様】医療保険で本リソースを使用する場合には、保険者組織Organizationリソースへの参照。自費の場合には、患者Patientリソースへの参照。公費の場合には、公費負担者組織Organizationリソースへの参照。

      32. Coverage.class
      Definition

      A suite of underwriter specific classifiers.
      保険事業者の分類子

      Comments

      For example may be used to identify a class of coverage or employer group, Policy, Plan.
      例えば、保険の種類または雇用者グループ、保険契約、Planを識別するために使用することができる。

      Requirements

      The codes provided on the health card which identify or confirm the specific policy for the insurer.
      健康カードに記載されているコードで、保険者の特定の保険契約を識別または確認するもの。

      34. Coverage.class.type
      Definition

      The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
      保険者固有のクラスラベルまたは番号、任意の名前が提供されている分類のタイプを表す。例えば、保険のクラスまたは雇用者グループ、保険契約、Planを識別するために使用することができる。

      Comments

      Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
      すべての用語の使用がこの一般的なパターンに適合するわけではない。いくつかのケースでは、モデルはCodeableConceptを使用せず、Codingを直接使用し、テキスト、コーディング、翻訳、要素間の関係、および前後の調整を管理するための独自の構造を提供することが望ましい。

      Requirements

      The insurer issued label for a specific health card value.
      保険者が発行した特定の健康カード番号のラベル。

      36. Coverage.class.value
      Definition

      The alphanumeric string value associated with the insurer issued label.
      保険者が発行したラベルに関連付けられた英数字の文字列値。

      Comments

      For example, the Group or Plan number.
      例えば、グループ番号やプラン番号など。

      Requirements

      The insurer issued label and value are necessary to identify the specific policy.
      保険者が発行したラベルと値は、特定の保険契約を識別するために必要なものである。

      38. Coverage.class.name
      Definition

      A short description for the class.
      保険種類の簡単な説明。

      Requirements

      Used to provide a meaningful description in correspondence to the patient.
      患者に対応するのに意味のある説明をするために使用する。

      40. Coverage.order
      Definition

      The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
      現在適用されている他の保障と比較して、この保障の適用可能性が高い順に記載されている。なお、ナンバリングにギャップがある場合があり、カバーの具体的な位置づけはケアのエピソードに依存するため、一次、二次などを意味するものではない。

      Comments

      32 bit number; for values larger than this, use decimal
      32 ビットの数値、これより大きい値の場合は 10 進数を使用する。

      Requirements

      Used in managing the coordination of benefits.
      保険給付の調整管理に使用する。
      【JP Core仕様】公費情報で本リソースを使用する場合で、複数の公費負担情報がある場合に、その適用順序番号を示す1,2,3...を設定する。

      42. Coverage.network
      Definition

      The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
      保険者が定義したプロバイダの保険者定義ネットワークの保険者固有の識別子で、被保険者が「ネットワーク内」の料金でカバーされる治療を受けることができるが、そうでなければ「ネットワーク外」の条件が適用される。

      Requirements

      Used in referral for treatment and in claims processing.
      治療のための紹介や請求処理の際に使用する。

      44. Coverage.costToBeneficiary
      Definition

      A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
      ポリシに詳細が記載されており、ヘルスカードに含まれている可能性のあるコストカテゴリと関連する金額を示す一連のコード。

      ShortPatient payments for services/products サービスやプロダクトに対する患者支払い
      Comments

      For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
      例えば、患者の訪問時の自己負担額を知ることで、医療提供者は治療を行う前にその金額を回収することができる。
      【JP Core仕様】公費の場合には自己負担率。判明している場合のみ設定する。

      Requirements

      Required by providers to manage financial transaction with the patient.
      事業者が患者との金銭的な取引を管理するために必要となる。

      46. Coverage.costToBeneficiary.type
      Definition

      The category of patient centric costs associated with treatment.
      治療に伴う患者中心の費用のカテゴリー。

      Comments

      For example visit, specialist visits, emergency, inpatient care, etc.
      例えば、訪問診療、専門医の訪問診療、救急診療、入院診療など。

      Requirements

      Needed to identify the category associated with the amount for the patient.
      患者の金額に関連するカテゴリーを特定する必要があった。

      48. Coverage.costToBeneficiary.type.coding
      50. Coverage.costToBeneficiary.type.coding.system
      Comments

      The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
      保険や公費における自己負担率の種別を識別するコード体系のコード。
      "http://terminology.hl7.org/CodeSystem/coverage-copay-type"

      52. Coverage.costToBeneficiary.type.coding.code
      Comments

      Note that FHIR strings SHALL NOT exceed 1MB in size
      自己負担率を表すコード "copaypct"

      54. Coverage.costToBeneficiary.value[x]
      Definition

      The amount due from the patient for the cost category.
      費用区分の患者からの支払額。

      Comments

      Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.
      金額は、サービス/製品のコストに対する割合で表現される場合と、通貨の固定額で表現される場合がある。

      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Requirements

      Needed to identify the amount for the patient associated with the category.
      カテゴリーに関連する患者の支払い金額を特定する必要があった

      56. Coverage.costToBeneficiary.exception
      Definition

      A suite of codes indicating exceptions or reductions to patient costs and their effective periods.
      患者費用の例外または削減を示すコードとその有効期間を示すコード群。

      Requirements

      Required by providers to manage financial transaction with the patient.
      事業者が患者との金銭的な取引を管理するために必要となる。

      58. Coverage.costToBeneficiary.exception.type
      Definition

      The code for the specific exception.
      特定の例外のコード。

      Requirements

      Needed to identify the exception associated with the amount for the patient.
      患者の金額に関連する例外を特定する必要があった。

      60. Coverage.costToBeneficiary.exception.period
      Definition

      The timeframe during when the exception is in force.
      例外が発生している間の時間枠。

      Requirements

      Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
      患者の費用を正しく計算するための例外の適用時期を特定する必要があった。

      62. Coverage.subrogation
      Definition

      When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
      subrogation=trueの場合、この保険インスタンスは裁定のためではなく、保険者に費用回収のための詳細を提供するために含まれている。 (subrogation=代位、subrogation payment=代位納付)

      ShortReimbursement to insurer 保険者への償還
      Comments

      Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
      一般的に、自動車保険や労災保険では、医療費支払い者が事故請求に対して回収できるように、subrogation=true というフラグが立てられている。

      Requirements

      See definition for when to be used.
      使用時期については定義を参照すること。

      64. Coverage.contract
      Definition

      The policy(s) which constitute this insurance coverage.
      この保険の適用範囲を構成するポリシ。

      ShortContract details 契約の詳細
      Comments

      References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
      参照は、実際のFHIRリソースへの参照である必要があり、解決可能(内容に到達可能)である必要がある(アクセス制御、一時的な使用不可などを考慮に入れる)。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。

      Requirements

      To reference the legally binding contract between the policy holder and the insurer.
      契約者と保険者との間の法的拘束力のある契約を参照するため。

      Guidance on how to interpret the contents of this table can be found here

      0. Coverage
      Definition

      Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.
      ヘルスケア製品およびサービスの償還または支払いに使用される可能性のある金融商品。 保険と自己負担の両方が含まれる。

      ShortInsurance or medical plan or a payment agreement 保険または医療費支払いプラン、または合意された支払い方法
      Comments

      The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.
      Coverageには、保険証レベルの情報が含まれている。これは、保険金請求やプロバイダと保険会社間のその他の通信で提供するのが通例である。

      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If 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-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. Coverage.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      4. Coverage.meta
      Definition

      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. Coverage.implicitRules
      Definition

      A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

      ShortA set of rules under which this content was created
      Comments

      Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. Coverage.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

      Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      IETF language tag

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. Coverage.text
      Definition

      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

      ShortText summary of the resource, for human interpretation
      Comments

      Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. Coverage.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

      ShortContained, inline Resources
      Comments

      This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

      Control0..*
      TypeResource
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      Invariantsdom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic))
      14. Coverage.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Coverage.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Coverage.extension:insuredPersonSymbol
        Slice NameinsuredPersonSymbol
        Definition

        健康保険における被保険者証記号を示す拡張

        Short健康保険における被保険者証記号
        Comments

        健康保険における被保険者証記号を示す拡張。被保険者記号の全角文字列。

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(JP Core Coverage InsuredPersonSymbol Extension) (Extension Type: string)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. Coverage.extension:insuredPersonNumber
        Slice NameinsuredPersonNumber
        Definition

        健康保険における被保険者証番号を示す拡張

        Short健康保険における被保険者証番号
        Comments

        健康保険における被保険者証番号を示す拡張。被保険者記号の全角文字列。

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(JP Core Coverage InsuredPersonNumber Extension) (Extension Type: string)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        20. Coverage.extension:insuredPersonSubNumber
        Slice NameinsuredPersonSubNumber
        Definition

        健康保険における被保険者証番号の枝番を示す拡張

        Short健康保険における被保険者証番号の枝番
        Comments

        健康保険における被保険者証番号を示す拡張。2桁の全角数字文字列。一桁の場合には先頭に0をつけて2桁にする。

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(JP Core Coverage InsuredPersonSubNumber Extension) (Extension Type: string)
        Is Modifierfalse
        Must Supportfalse
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        22. Coverage.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Must Supportfalse
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        24. Coverage.identifier
        Definition

        A unique identifier assigned to this coverage.
        このカバレッジに割り当てられた一意の識別子。

        ShortBusiness Identifier for the coverage このカバレッジに割り当てられた一意の識別子【詳細参照】
        Comments

        The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependent.
        カバレッジのメイン(および場合によっては唯一の)識別子-多くの場合、メンバID、証明書番号、個人の健康番号、またはケースIDと呼ばれる。
        【JP Core仕様】被保険者記号と番号と枝番を全角にした上でダブルコーテーションで囲い、カンマ区切りで連結する。
        ルール:"{被保険者記号}","{被保険者番号}","{枝番}"
        例:"12-34","5678","00"

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..*
        TypeIdentifier
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Allows coverages to be distinguished and referenced.
        カバレッジを区別して参照できるようにする。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Coverage.status
        Definition

        The status of the resource instance.
        リソースインスタンスのステータス。

        Shortactive | cancelled | draft | entered-in-error
        Comments

        This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.
        ステータスには、カバレッジが現在無効であることを示すエラー入力されたコードが含まれているため、この要素は修飾子としてラベル付けされる。

        Control1..1
        BindingThe codes SHALL be taken from FinancialResourceStatusCodes
        (required to http://hl7.org/fhir/ValueSet/fm-status|4.3.0)

        A code specifying the state of the resource instance.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
        「ドラフト」リソースはさらに編集される可能性があり、「アクティブ」リソースは不変であり、ステータスが「キャンセル」に変更されるだけである可能性があるため、リソースのステータスを追跡する必要がある。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. Coverage.type
        Definition

        The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.
        補償の種類:社会プログラム、医療計画、事故補償(労働者災害補償、自動車)、グループの健康、または個人または組織による支払い。

        ShortCoverage category such as medical or accident 医療保険や事故補償のような分類
        Comments

        Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
        すべてのターミノロジの使用がこの一般的なパターンに適合するわけではない。場合によっては、モデルはCodeableConceptを使用せず、コーディングを直接使用して、テキスト、コーディング、翻訳、および要素間の関係とpre-coordinationとpost-coordinationの用語関係を管理するための独自の構造を提供する必要がある。
        【JP Core仕様】「処方情報 HL7FHIR 記述仕様」等で使用される保険種別コード(system=”urn:oid:1.2.392.100495.20.2.61”)として、https://www.mhlw.go.jp/content/10800000/000342368.pdf の別表11が使用している例があげられている。JP Coreとして本項目に対する用語のバインドは現時点では定義するまでに至っていない。

        Control0..1
        BindingThe codes SHOULD be taken from CoverageTypeAndSelf-PayCodes
        (preferred to http://hl7.org/fhir/ValueSet/coverage-type)

        The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        The order of application of coverages is dependent on the types of coverage.
        カバレッジの適用順序は、カバレッジのタイプによって異なる。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Coverage.policyHolder
        Definition

        The party who 'owns' the insurance policy.
        保険証券を「所有する」当事者。

        ShortOwner of the policy ポリシの所有者
        Comments

        For example: may be an individual, corporation or the subscriber's employer.
        例:個人、企業、または加入者の雇用主である可能性がある。

        Control0..1
        TypeReference(JP Core Patient Profile, RelatedPerson, JP Core Organization Profile)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        This provides employer information in the case of Worker's Compensation and other policies.
        これは、労働者災害補償およびその他のポリシの場合に雇用者情報を提供する。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Coverage.subscriber
        Definition

        The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.
        ポリシにサインアップした、またはポリシとの契約関係を「所有」している当事者、またはポリシの利益が彼らまたはその家族に提供されることになっている当事者。

        ShortSubscriber to the policy 被保険者
        Comments

        May be self or a parent in the case of dependents.
        扶養家族の場合、自己または親である可能性がある。

        Control0..1
        TypeReference(JP Core Patient Profile, RelatedPerson)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        This is the party who is entitled to the benefits under the policy.
        これは、ポリシに基づいて給付を受ける権利を有する当事者である。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Coverage.subscriberId
        Definition

        The insurer assigned ID for the Subscriber.
        被保険者に保険者が割り当てたID

        ShortID assigned to the subscriber 被保険者に割り当てられたID
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        The insurer requires this identifier on correspondence and claims (digital and otherwise).
        保険者は、連絡や請求(デジタルおよびその他)でこの識別子を要求する。
        保険会社は、通信および請求(デジタルおよびその他)でこの識別子を要求する。
        【JP Core仕様】被保険者記号と番号を全角にした上でダブルコーテーションで囲い、カンマ区切りで連結する。
        ルール:"{被保険者記号}","{被保険者番号}"
        例:"12-34","5678"

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Coverage.beneficiary
        Definition

        The party who benefits from the insurance coverage; the patient when products and/or services are provided.
        保険適用から利益を得る当事者、製品および/またはサービスが提供される際の患者。

        ShortPlan beneficiary
        Comments

        References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
        参照は、実際のFHIRリソースへの参照である必要があり、解決可能(内容に到達可能)である必要がある(アクセス制御、一時的な使用不可などを考慮に入れる)。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。
        【JP Core仕様】患者Patientリソースへの参照。

        Control1..1
        TypeReference(JP Core Patient Profile)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        This is the party who receives treatment for which the costs are reimbursed under the coverage.
        これは、補償の下で費用が償還される治療を受ける側のことである。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Coverage.dependent
        Definition

        A unique identifier for a dependent under the coverage.
        被保険者証の枝番。

        Short被保険者証 枝番
        Comments

        Periodically the member number is constructed from the subscriberId and the dependent number.
        被保険者証の枝番を全角で格納する。

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.
        一部の補償では、単一の識別子が加入者に発行され、次に一意の従属番号が各受益者に発行される。
        一部の保険では、単一の識別子が加入者に発行され、その後、各受益者に固有の扶養番号が発行される。
        【JP Core仕様】医療保険で本リソースを使用する場合には、この要素に拡張 InsuredPersonSubNumberに設定した値と同じ、被保険者番号の枝番号全角2桁を設定する。
        例:"00"

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Coverage.relationship
        Definition

        The relationship of beneficiary (patient) to the subscriber.
        受益者(患者)と加入者の関係。

        ShortBeneficiary relationship to the subscriber 加入者との受益者関係
        Comments

        Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.
        一般的に、個人は、他人が所有するポリシよりも、自分のポリシ(relationship='self')を使用する。

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from SubscriberRelationshipCodes
        (extensible to http://hl7.org/fhir/ValueSet/subscriber-relationship)

        The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        To determine relationship between the patient and the subscriber to determine coordination of benefits.
        患者と加入者の関係を決定し、給付の調整を決定する。
        【JP Core仕様】「処方情報 HL7FHIR 記述仕様」等で使用される被保険者区分コード(system=”urn:oid:1.2.392.100495.20.2.62”)として、https://www.mhlw.go.jp/content/10800000/000342368.pdf の別表12が使用できる。
         1 被保険者
         2 被扶養者

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Coverage.period
        Definition

        Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.
        補償範囲が有効である期間。開始日が欠落している場合は、開始日が不明であることを示す。終了日が欠落している場合は、補償範囲が引き続き有効であることを意味する。

        ShortCoverage start and end dates
        Comments

        A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration.
        Period(期間)は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、範囲から1つの値が適用されるか(たとえば、「この2回の間に患者に投与する」)を指定する。
        Period(期間)は、Duration(時間区間=経過時間の測定値)には使用されない。 [Duration](datatypes.html#Duration)を参照のこと。
        This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). If duration is required, specify the type as Interval|Duration.
        これはDuration(時間区間)ではない- Durationは時間の尺度(別のタイプ)だが、時間の固定値で発生する時間区間である。Period(期間)は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、範囲から1つの値が適用されるか(たとえば、「この2回の間に患者に投与する」)を指定する。もし、Duration(時間区間)が必要な場合は、タイプをInterval | Durationとして指定する。
        これは期間ではなく-これは時間の尺度(別のタイプ)あるが、時間の固定値で発生する期間である。期間は時間の範囲を指定する。使用状況は、範囲全体が適用されるか(たとえば、「患者はこの時間範囲で入院していた」)、または範囲から1つの値が適用されるか(たとえば、「これら2回の間に患者に与える」)を指定する。期間が必要な場合は、タイプをInterval | Durationとして指定する。
        【JP Core仕様】医療保険、公費で本リソースを使用する場合には、保険証または公費の有効期間の開始日、終了日をstart とendに yyyy-mm-dd形式で設定する。

        Control0..1
        TypePeriod
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Some insurers require the submission of the coverage term.
        保険会社によっては、補償期間の提出を義務付けているところもある。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Coverage.payor
        Definition

        The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
        患者負担契約などの保険契約と保険外契約の両方を含むプログラムまたはプランの引受人または支払人。

        ShortIssuer of the policy
        Comments

        May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.
        保険会社の識別子や事業者の識別子(BIN番号)など、複数の識別子を提供してもよい。自己負担の場合は、複数の支払者および/または組織を提供してもよい。

        Control1..*
        TypeReference(JP Core Organization Profile, JP Core Patient Profile, RelatedPerson)
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Need to identify the issuer to target for claim processing and for coordination of benefit processing.
        請求処理および給付処理の調整の対象となる発行者を特定する必要がある。
        【JP Core仕様】医療保険で本リソースを使用する場合には、保険者組織Organizationリソースへの参照。自費の場合には、患者Patientリソースへの参照。公費の場合には、公費負担者組織Organizationリソースへの参照。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. Coverage.class
        Definition

        A suite of underwriter specific classifiers.
        保険事業者の分類子

        ShortAdditional coverage classifications
        Comments

        For example may be used to identify a class of coverage or employer group, Policy, Plan.
        例えば、保険の種類または雇用者グループ、保険契約、Planを識別するために使用することができる。

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        The codes provided on the health card which identify or confirm the specific policy for the insurer.
        健康カードに記載されているコードで、保険者の特定の保険契約を識別または確認するもの。

        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        48. Coverage.class.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        50. Coverage.class.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        52. Coverage.class.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        54. Coverage.class.type
        Definition

        The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.
        保険者固有のクラスラベルまたは番号、任意の名前が提供されている分類のタイプを表す。例えば、保険のクラスまたは雇用者グループ、保険契約、Planを識別するために使用することができる。

        ShortType of class such as 'group' or 'plan'
        Comments

        Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
        すべての用語の使用がこの一般的なパターンに適合するわけではない。いくつかのケースでは、モデルはCodeableConceptを使用せず、Codingを直接使用し、テキスト、コーディング、翻訳、要素間の関係、および前後の調整を管理するための独自の構造を提供することが望ましい。

        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from CoverageClassCodes
        (extensible to http://hl7.org/fhir/ValueSet/coverage-class)

        The policy classifications, eg. Group, Plan, Class, etc.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        The insurer issued label for a specific health card value.
        保険者が発行した特定の健康カード番号のラベル。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. Coverage.class.value
        Definition

        The alphanumeric string value associated with the insurer issued label.
        保険者が発行したラベルに関連付けられた英数字の文字列値。

        ShortValue associated with the type
        Comments

        For example, the Group or Plan number.
        例えば、グループ番号やプラン番号など。

        Control1..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        The insurer issued label and value are necessary to identify the specific policy.
        保険者が発行したラベルと値は、特定の保険契約を識別するために必要なものである。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. Coverage.class.name
        Definition

        A short description for the class.
        保険種類の簡単な説明。

        ShortHuman readable description of the type and value
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Used to provide a meaningful description in correspondence to the patient.
        患者に対応するのに意味のある説明をするために使用する。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. Coverage.order
        Definition

        The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.
        現在適用されている他の保障と比較して、この保障の適用可能性が高い順に記載されている。なお、ナンバリングにギャップがある場合があり、カバーの具体的な位置づけはケアのエピソードに依存するため、一次、二次などを意味するものではない。

        ShortRelative order of the coverage
        Comments

        32 bit number; for values larger than this, use decimal
        32 ビットの数値、これより大きい値の場合は 10 進数を使用する。

        Control0..1
        TypepositiveInt
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Used in managing the coordination of benefits.
        保険給付の調整管理に使用する。
        【JP Core仕様】公費情報で本リソースを使用する場合で、複数の公費負担情報がある場合に、その適用順序番号を示す1,2,3...を設定する。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. Coverage.network
        Definition

        The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
        保険者が定義したプロバイダの保険者定義ネットワークの保険者固有の識別子で、被保険者が「ネットワーク内」の料金でカバーされる治療を受けることができるが、そうでなければ「ネットワーク外」の条件が適用される。

        ShortInsurer network
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Used in referral for treatment and in claims processing.
        治療のための紹介や請求処理の際に使用する。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        64. Coverage.costToBeneficiary
        Definition

        A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
        ポリシに詳細が記載されており、ヘルスカードに含まれている可能性のあるコストカテゴリと関連する金額を示す一連のコード。

        ShortPatient payments for services/products サービスやプロダクトに対する患者支払い
        Comments

        For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
        例えば、患者の訪問時の自己負担額を知ることで、医療提供者は治療を行う前にその金額を回収することができる。
        【JP Core仕様】公費の場合には自己負担率。判明している場合のみ設定する。

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Requirements

        Required by providers to manage financial transaction with the patient.
        事業者が患者との金銭的な取引を管理するために必要となる。

        Alternate NamesCoPay, Deductible, Exceptions
        Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
        66. Coverage.costToBeneficiary.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        68. Coverage.costToBeneficiary.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        70. Coverage.costToBeneficiary.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        72. Coverage.costToBeneficiary.type
        Definition

        The category of patient centric costs associated with treatment.
        治療に伴う患者中心の費用のカテゴリー。

        ShortCost category
        Comments

        For example visit, specialist visits, emergency, inpatient care, etc.
        例えば、訪問診療、専門医の訪問診療、救急診療、入院診療など。

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from CoverageCopayTypeCodes
        (extensible to http://hl7.org/fhir/ValueSet/coverage-copay-type)

        The types of services to which patient copayments are specified.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Needed to identify the category associated with the amount for the patient.
        患者の金額に関連するカテゴリーを特定する必要があった。

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. Coverage.costToBeneficiary.type.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typeid
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        76. Coverage.costToBeneficiary.type.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Coverage.costToBeneficiary.type.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 78. Coverage.costToBeneficiary.type.coding
          Definition

          A reference to a code defined by a terminology system.

          ShortCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..*
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          80. Coverage.costToBeneficiary.type.coding.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typeid
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          82. Coverage.costToBeneficiary.type.coding.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on Coverage.costToBeneficiary.type.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 84. Coverage.costToBeneficiary.type.coding.system
            Definition

            The identification of the code system that defines the meaning of the symbol in the code.

            ShortIdentity of the terminology system
            Comments

            The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
            保険や公費における自己負担率の種別を識別するコード体系のコード。
            "http://terminology.hl7.org/CodeSystem/coverage-copay-type"

            Control0..1
            Typeuri
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to be unambiguous about the source of the definition of the symbol.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            86. Coverage.costToBeneficiary.type.coding.version
            Definition

            The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

            ShortVersion of the system - if relevant
            Comments

            Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

            NoteThis is a business version Id, not a resource version Id (see discussion)
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            88. Coverage.costToBeneficiary.type.coding.code
            Definition

            A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

            ShortSymbol in syntax defined by the system
            Comments

            Note that FHIR strings SHALL NOT exceed 1MB in size
            自己負担率を表すコード "copaypct"

            Control0..1
            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to refer to a particular code in the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            90. Coverage.costToBeneficiary.type.coding.display
            Definition

            A representation of the meaning of the code in the system, following the rules of the system.

            ShortRepresentation defined by the system
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            92. Coverage.costToBeneficiary.type.coding.userSelected
            Definition

            Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

            ShortIf this coding was chosen directly by the user
            Comments

            Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

            Control0..1
            Typeboolean
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            94. Coverage.costToBeneficiary.type.text
            Definition

            A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

            ShortPlain text representation of the concept
            Comments

            Very often the text is the same as a displayName of one of the codings.

            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summarytrue
            Requirements

            The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            96. Coverage.costToBeneficiary.value[x]
            Definition

            The amount due from the patient for the cost category.
            費用区分の患者からの支払額。

            ShortThe amount or percentage due from the beneficiary
            Comments

            Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.
            金額は、サービス/製品のコストに対する割合で表現される場合と、通貨の固定額で表現される場合がある。

            Control1..1
            TypeChoice of: Quantity(SimpleQuantity), Money
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Requirements

            Needed to identify the amount for the patient associated with the category.
            カテゴリーに関連する患者の支払い金額を特定する必要があった

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            98. Coverage.costToBeneficiary.exception
            Definition

            A suite of codes indicating exceptions or reductions to patient costs and their effective periods.
            患者費用の例外または削減を示すコードとその有効期間を示すコード群。

            ShortExceptions for patient payments
            Control0..*
            TypeBackboneElement
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Requirements

            Required by providers to manage financial transaction with the patient.
            事業者が患者との金銭的な取引を管理するために必要となる。

            Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
            100. Coverage.costToBeneficiary.exception.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            102. Coverage.costToBeneficiary.exception.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            104. Coverage.costToBeneficiary.exception.modifierExtension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

            Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

            ShortExtensions that cannot be ignored even if unrecognized
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
            Summarytrue
            Requirements

            Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

            Alternate Namesextensions, user content, modifiers
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            106. Coverage.costToBeneficiary.exception.type
            Definition

            The code for the specific exception.
            特定の例外のコード。

            ShortException category
            Control1..1
            BindingFor example codes, see ExampleCoverageFinancialExceptionCodes
            (example to http://hl7.org/fhir/ValueSet/coverage-financial-exception)

            The types of exceptions from the part or full value of financial obligations such as copays.

            TypeCodeableConcept
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Requirements

            Needed to identify the exception associated with the amount for the patient.
            患者の金額に関連する例外を特定する必要があった。

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            108. Coverage.costToBeneficiary.exception.period
            Definition

            The timeframe during when the exception is in force.
            例外が発生している間の時間枠。

            ShortThe effective period of the exception
            Control0..1
            TypePeriod
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Requirements

            Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
            患者の費用を正しく計算するための例外の適用時期を特定する必要があった。

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            110. Coverage.subrogation
            Definition

            When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
            subrogation=trueの場合、この保険インスタンスは裁定のためではなく、保険者に費用回収のための詳細を提供するために含まれている。 (subrogation=代位、subrogation payment=代位納付)

            ShortReimbursement to insurer 保険者への償還
            Comments

            Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
            一般的に、自動車保険や労災保険では、医療費支払い者が事故請求に対して回収できるように、subrogation=true というフラグが立てられている。

            Control0..1
            Typeboolean
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supportfalse
            Summaryfalse
            Requirements

            See definition for when to be used.
            使用時期については定義を参照すること。

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            112. Coverage.contract
            Definition

            The policy(s) which constitute this insurance coverage.
            この保険の適用範囲を構成するポリシ。

            ShortContract details 契約の詳細
            Comments

            References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
            参照は、実際のFHIRリソースへの参照である必要があり、解決可能(内容に到達可能)である必要がある(アクセス制御、一時的な使用不可などを考慮に入れる)。解決は、URLから取得するか、リソースタイプによって該当する場合は、絶対参照を正規URLとして扱い、ローカルレジストリ/リポジトリで検索することによって行うことができる。

            Control0..*
            TypeReference(Contract)
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Requirements

            To reference the legally binding contract between the policy holder and the insurer.
            契約者と保険者との間の法的拘束力のある契約を参照するため。

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            本実装ガイドへのご質問・ご指摘については、GitHub IssueおよびGitHub PullRequestにて受け付けております。