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 Core Coverage Profile

項目内容
定義URL http://jpfhir.jp/fhir/core/StructureDefinition/JP_Coverage
Version 2.0.0-dev
Name

JP_Coverage
Title

JP Core Coverage Profile
Status Active ( 2023-10-31 )
Copyright

Copyright FHIR Japanese implementation research working group in Japan Association of Medical Informatics (JAMI) 一般社団法人日本医療情報学会NeXEHRS課題研究会FHIR日本実装検討WG

このプロファイルはCoverageリソースに対して、保険・公費のデータを送受信するための基礎となる制約と拡張を定めたものである。

背景および想定シナリオ

本プロファイルは、以下のようなユースケースを想定している。

  • 病院の電子カルテシステムや医事システム、診療所や調剤薬局のシステム、介護サービスを提供する施設のシステム等において、サービス利用者（患者）の支払いに適用する保険や公費の種類、自己負担割合や自己負担上限額などを管理する
  • サービス利用者や保険者が実際に支払う負担額を管理する
  • サービス利用者や保険者を除く個人又は組織が支払いの全額又は一部に責任を持つ場合の負担額を管理する

スコープ


Coverageリソースは、医療・介護保険における識別子・記述子を提供することを想定しており、典型的には保険証に記載される情報であり、医療や介護サービスの提供に対する対価として、一部または全ての支払いに使用される可能性がある。

このリソースは、保険者以外の個人または組織が医療費の一部の支払いに責任を持つ「自己負担」を登録するためにも使用できる。ここで定義する「自己負担」は、患者の支払いの保証人になることとは別のものであることに留意する。

Coverage リソースは、FHIRワークフローの観点からは「イベント」に該当するリソースである。詳細はWorkflowの項目を参照のこと。

プロファイル定義

Usage:

プロファイル詳細

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance 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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:insuredPersonSymbol 0..* string 健康保険における被保険者証記号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSymbol
.... extension:insuredPersonNumber 0..* string 健康保険における被保険者証番号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonNumber
.... extension:insuredPersonSubNumber 0..* string 健康保険における被保険者証番号の枝番
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSubNumber
... identifier 0..* Identifier Business 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】
... status 1..1 code active | cancelled | draft | entered-in-error
... type 0..1 CodeableConcept Coverage category such as medical or accident　医療保険や事故補償のような分類
... policyHolder 0..1 Reference(JP Core Patient Profile | RelatedPerson | JP Core Organization Profile) Owner of the policy　ポリシの所有者
... subscriber 0..1 Reference(JP Core Patient Profile | RelatedPerson) Subscriber to the policy　被保険者
... subscriberId 0..1 string ID assigned to the subscriber　被保険者に割り当てられたID
... beneficiary 1..1 Reference(JP Core Patient Profile) Plan beneficiary
... dependent 0..1 string 被保険者証 枝番
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber　加入者との受益者関係
... period 0..1 Period Coverage start and end dates
... payor 1..* Reference(JP Core Organization Profile | JP Core Patient Profile | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
.... value 1..1 string Value associated with the type
.... name 0..1 string Human readable description of the type and value
... order 0..1 positiveInt Relative order of the coverage
... network 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products　サービスやプロダクトに対する患者支払い
.... type 0..1 CodeableConcept Cost category
..... coding
...... system 0..1 uri Identity of the terminology system
...... code 0..1 code Symbol in syntax defined by the system
.... value[x] 1..1 SimpleQuantity, Money The amount or percentage due from the beneficiary
.... exception 0..* BackboneElement Exceptions for patient payments
..... type 1..1 CodeableConcept Exception category
..... period 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer　保険者への償還
... contract 0..* Reference(Contract) Contract details　契約の詳細

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance 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
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... extension:insuredPersonSymbol 0..* string 健康保険における被保険者証記号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSymbol
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
ext-1: Must have either extensions or value[x], not both
.... extension:insuredPersonNumber 0..* string 健康保険における被保険者証番号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonNumber
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
ext-1: Must have either extensions or value[x], not both
.... extension:insuredPersonSubNumber 0..* string 健康保険における被保険者証番号の枝番
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSubNumber
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier Σ 0..* Identifier Business 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】
ele-1: All FHIR elements must have a @value or children
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


ele-1: All FHIR elements must have a @value or children
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident　医療保険や事故補償のような分類
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.


ele-1: All FHIR elements must have a @value or children
... policyHolder Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson | JP Core Organization Profile) Owner of the policy　ポリシの所有者
ele-1: All FHIR elements must have a @value or children
... subscriber Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson) Subscriber to the policy　被保険者
ele-1: All FHIR elements must have a @value or children
... subscriberId Σ 0..1 string ID assigned to the subscriber　被保険者に割り当てられたID
ele-1: All FHIR elements must have a @value or children
... beneficiary Σ 1..1 Reference(JP Core Patient Profile) Plan beneficiary
ele-1: All FHIR elements must have a @value or children
... dependent Σ 0..1 string 被保険者証 枝番
ele-1: All FHIR elements must have a @value or children
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber　加入者との受益者関係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).


ele-1: All FHIR elements must have a @value or children
... period Σ 0..1 Period Coverage start and end dates
ele-1: All FHIR elements must have a @value or children
... payor Σ 1..* Reference(JP Core Organization Profile | JP Core Patient Profile | RelatedPerson) Issuer of the policy
ele-1: All FHIR elements must have a @value or children
... class 0..* BackboneElement Additional coverage classifications
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


ele-1: All FHIR elements must have a @value or children
.... value Σ 1..1 string Value associated with the type
ele-1: All FHIR elements must have a @value or children
.... name Σ 0..1 string Human readable description of the type and value
ele-1: All FHIR elements must have a @value or children
... order Σ 0..1 positiveInt Relative order of the coverage
ele-1: All FHIR elements must have a @value or children
... network Σ 0..1 string Insurer network
ele-1: All FHIR elements must have a @value or children
... costToBeneficiary 0..* BackboneElement Patient payments for services/products　サービスやプロダクトに対する患者支払い
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.


ele-1: All FHIR elements must have a @value or children
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
ele-1: All FHIR elements must have a @value or children
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.


ele-1: All FHIR elements must have a @value or children
..... period Σ 0..1 Period The effective period of the exception
ele-1: All FHIR elements must have a @value or children
... subrogation 0..1 boolean Reimbursement to insurer　保険者への償還
ele-1: All FHIR elements must have a @value or children
... contract 0..* Reference(Contract) Contract details　契約の詳細
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance 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
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): IETF language tag

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
dom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:insuredPersonSymbol 0..* string 健康保険における被保険者証記号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSymbol
.... extension:insuredPersonNumber 0..* string 健康保険における被保険者証番号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonNumber
.... extension:insuredPersonSubNumber 0..* string 健康保険における被保険者証番号の枝番
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSubNumber
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business 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】
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident　医療保険や事故補償のような分類
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson | JP Core Organization Profile) Owner of the policy　ポリシの所有者
... subscriber Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson) Subscriber to the policy　被保険者
... subscriberId Σ 0..1 string ID assigned to the subscriber　被保険者に割り当てられたID
... beneficiary Σ 1..1 Reference(JP Core Patient Profile) Plan beneficiary
... dependent Σ 0..1 string 被保険者証 枝番
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber　加入者との受益者関係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(JP Core Organization Profile | JP Core Patient Profile | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products　サービスやプロダクトに対する患者支払い
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding Code defined by a terminology system
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 0..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 0..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer　保険者への償還
... contract 0..* Reference(Contract) Contract details　契約の詳細

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.3.0
from the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where(((id.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-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
dom-r4bwarningCoverage.containedContaining 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)
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance 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
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:insuredPersonSymbol 0..* string 健康保険における被保険者証記号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSymbol
.... extension:insuredPersonNumber 0..* string 健康保険における被保険者証番号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonNumber
.... extension:insuredPersonSubNumber 0..* string 健康保険における被保険者証番号の枝番
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSubNumber
... identifier 0..* Identifier Business 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】
... status 1..1 code active | cancelled | draft | entered-in-error
... type 0..1 CodeableConcept Coverage category such as medical or accident　医療保険や事故補償のような分類
... policyHolder 0..1 Reference(JP Core Patient Profile | RelatedPerson | JP Core Organization Profile) Owner of the policy　ポリシの所有者
... subscriber 0..1 Reference(JP Core Patient Profile | RelatedPerson) Subscriber to the policy　被保険者
... subscriberId 0..1 string ID assigned to the subscriber　被保険者に割り当てられたID
... beneficiary 1..1 Reference(JP Core Patient Profile) Plan beneficiary
... dependent 0..1 string 被保険者証 枝番
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber　加入者との受益者関係
... period 0..1 Period Coverage start and end dates
... payor 1..* Reference(JP Core Organization Profile | JP Core Patient Profile | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
.... value 1..1 string Value associated with the type
.... name 0..1 string Human readable description of the type and value
... order 0..1 positiveInt Relative order of the coverage
... network 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products　サービスやプロダクトに対する患者支払い
.... type 0..1 CodeableConcept Cost category
..... coding
...... system 0..1 uri Identity of the terminology system
...... code 0..1 code Symbol in syntax defined by the system
.... value[x] 1..1 SimpleQuantity, Money The amount or percentage due from the beneficiary
.... exception 0..* BackboneElement Exceptions for patient payments
..... type 1..1 CodeableConcept Exception category
..... period 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer　保険者への償還
... contract 0..* Reference(Contract) Contract details　契約の詳細

doco Documentation for this format

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance 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
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
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
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... extension:insuredPersonSymbol 0..* string 健康保険における被保険者証記号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSymbol
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
ext-1: Must have either extensions or value[x], not both
.... extension:insuredPersonNumber 0..* string 健康保険における被保険者証番号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonNumber
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
ext-1: Must have either extensions or value[x], not both
.... extension:insuredPersonSubNumber 0..* string 健康保険における被保険者証番号の枝番
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSubNumber
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
ext-1: Must have either extensions or value[x], not both
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier Σ 0..* Identifier Business 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】
ele-1: All FHIR elements must have a @value or children
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.


ele-1: All FHIR elements must have a @value or children
... type Σ 0..1 CodeableConcept Coverage category such as medical or accident　医療保険や事故補償のような分類
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.


ele-1: All FHIR elements must have a @value or children
... policyHolder Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson | JP Core Organization Profile) Owner of the policy　ポリシの所有者
ele-1: All FHIR elements must have a @value or children
... subscriber Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson) Subscriber to the policy　被保険者
ele-1: All FHIR elements must have a @value or children
... subscriberId Σ 0..1 string ID assigned to the subscriber　被保険者に割り当てられたID
ele-1: All FHIR elements must have a @value or children
... beneficiary Σ 1..1 Reference(JP Core Patient Profile) Plan beneficiary
ele-1: All FHIR elements must have a @value or children
... dependent Σ 0..1 string 被保険者証 枝番
ele-1: All FHIR elements must have a @value or children
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber　加入者との受益者関係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).


ele-1: All FHIR elements must have a @value or children
... period Σ 0..1 Period Coverage start and end dates
ele-1: All FHIR elements must have a @value or children
... payor Σ 1..* Reference(JP Core Organization Profile | JP Core Patient Profile | RelatedPerson) Issuer of the policy
ele-1: All FHIR elements must have a @value or children
... class 0..* BackboneElement Additional coverage classifications
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.


ele-1: All FHIR elements must have a @value or children
.... value Σ 1..1 string Value associated with the type
ele-1: All FHIR elements must have a @value or children
.... name Σ 0..1 string Human readable description of the type and value
ele-1: All FHIR elements must have a @value or children
... order Σ 0..1 positiveInt Relative order of the coverage
ele-1: All FHIR elements must have a @value or children
... network Σ 0..1 string Insurer network
ele-1: All FHIR elements must have a @value or children
... costToBeneficiary 0..* BackboneElement Patient payments for services/products　サービスやプロダクトに対する患者支払い
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.


ele-1: All FHIR elements must have a @value or children
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
ele-1: All FHIR elements must have a @value or children
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
ele-1: All FHIR elements must have a @value or children unless an empty Parameters resource
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.


ele-1: All FHIR elements must have a @value or children
..... period Σ 0..1 Period The effective period of the exception
ele-1: All FHIR elements must have a @value or children
... subrogation 0..1 boolean Reimbursement to insurer　保険者への償還
ele-1: All FHIR elements must have a @value or children
... contract 0..* Reference(Contract) Contract details　契約の詳細
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage 0..* Coverage Insurance 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
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): IETF language tag

Additional BindingsPurpose
AllLanguages Max Binding
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
dom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:insuredPersonSymbol 0..* string 健康保険における被保険者証記号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSymbol
.... extension:insuredPersonNumber 0..* string 健康保険における被保険者証番号
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonNumber
.... extension:insuredPersonSubNumber 0..* string 健康保険における被保険者証番号の枝番
URL: http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSubNumber
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Business 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】
... status ?!Σ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.

... type Σ 0..1 CodeableConcept Coverage category such as medical or accident　医療保険や事故補償のような分類
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.

... policyHolder Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson | JP Core Organization Profile) Owner of the policy　ポリシの所有者
... subscriber Σ 0..1 Reference(JP Core Patient Profile | RelatedPerson) Subscriber to the policy　被保険者
... subscriberId Σ 0..1 string ID assigned to the subscriber　被保険者に割り当てられたID
... beneficiary Σ 1..1 Reference(JP Core Patient Profile) Plan beneficiary
... dependent Σ 0..1 string 被保険者証 枝番
... relationship 0..1 CodeableConcept Beneficiary relationship to the subscriber　加入者との受益者関係
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(JP Core Organization Profile | JP Core Patient Profile | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.

.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products　サービスやプロダクトに対する患者支払い
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.

..... id 0..1 id Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ 0..* Coding Code defined by a terminology system
...... id 0..1 id Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ 0..1 uri Identity of the terminology system
...... version Σ 0..1 string Version of the system - if relevant
...... code Σ 0..1 code Symbol in syntax defined by the system
...... display Σ 0..1 string Representation defined by the system
...... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
..... text Σ 0..1 string Plain text representation of the concept
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.

..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer　保険者への償還
... contract 0..* Reference(Contract) Contract details　契約の詳細

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Coverage.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
Coverage.statusrequiredFinancialResourceStatusCodes
http://hl7.org/fhir/ValueSet/fm-status|4.3.0
from the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
from the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
from the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
from the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where(((id.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-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
dom-r4bwarningCoverage.containedContaining 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)
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

 

Other representations of profile: CSV, Excel, Schematron

必須要素

Coverage リソースは、次の要素を必ず持たなければならない。

  • status ： 「リソースのインスタンスの状態」を示すエレメント
  • beneficiary : 「サービスを受ける者」を示すエレメント、Patientリソースを参照する
  • payor ： 「負担者」を示すエレメント。Organization、Patient、RelatedPersonのいずれかを参照する

Extensions定義

JP Core Coverage プロファイルで使用される拡張は次の通りである。

利用方法

OperationおよびSearch Parameter 一覧

Search Parameter一覧

コンフォーマンス パラメータ 型 例
SHALL identifier token GET [base]/Coverage?identifier=***
SHOULD beneficiary reference GET [base]/Coverage?beneficiary=***
SHOULD class-type token GET [base]/Coverage?class-type=***
SHOULD class-value string GET [base]/Coverage?class-value=***
SHOULD dependent string GET [base]/Coverage?dependent=***
SHOULD patient reference GET [base]/Coverage?patient=Patient/***
SHOULD payor reference GET [base]/Coverage?payor=***
SHOULD policy-holder reference GET [base]/Coverage?policy-holder=***
SHOULD status token GET [base]/Coverage?status=***
SHOULD subscriber reference GET [base]/Coverage?subscriber=***
SHOULD type token GET [base]/Coverage?type=***
必須検索パラメータ

  1. identifier 検索パラメータを使用して、識別子によるCoverageの検索をサポートしなければならない（SHALL）

    GET [base]/Coverage?identifier={system|}[token]

    例：

    GET [base]/Coverage?identifier=http://abchosptal.co.jp/coverage/idsys|123456

    指定された識別子に一致するCoverageリソースを含むBundleを検索する。

推奨検索パラメータ

次の検索パラメータをサポートすることが望ましい。

  1. beneficiary 検索パラメータを使用して、識別子によるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?beneficiary=[reference]

    例：

    GET [base]/Coverage?beneficiary=*****

    指定された識別子に一致するCoverageリソースを含むBundleを検索する。

  2. class-type 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?class-type={token}

    例：

    GET [base]/Coverage?class-type=*****

    指定されたclass-typeに一致するCoverageリソースを含むBundleを検索する。

  3. class-value 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?class-value={string}

    例：

    GET [base]/Coverage?class-value=*****

    指定されたclass-valueに一致するCoverageリソースを含むBundleを検索する。

  4. dependent 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?dependent={string}

    例：

    GET [base]/Coverage?dependent=*****

    指定されたdependentに一致するCoverageリソースを含むBundleを検索する。

  5. patient 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?patient={reference}

    例：

    GET [base]/Coverage?patient=*****

    指定されたpatientに一致するCoverageリソースを含むBundleを検索する。

  6. payor 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?payor={reference}

    例：

    GET [base]/Coverage?payor=*****

    指定されたpayorに一致するCoverageリソースを含むBundleを検索する。

  7. policy-holder 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?policy-holder={reference}

    例：

    GET [base]/Coverage?policy-holder=*****

    指定されたpolicy-holderに一致するCoverageリソースを含むBundleを検索する。

  8. status 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?status={token}

    例：

    GET [base]/Coverage?status=*****

    指定されたstatusに一致するCoverageリソースを含むBundleを検索する。

  9. subscriber 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?subscriber={reference}

    例：

    GET [base]/Coverage?subscriber=*****

    指定された識subscriberに一致するCoverageリソースを含むBundleを検索する。

  10. type 検索パラメータを使用して、言語コードによるCoverageの検索をサポートすることが望ましい（SHOULD）

    GET [base]/Coverage?type={string}

    例：

    GET [base]/Coverage?type=*****

    指定されたtypeに一致するCoverageリソースを含むBundleを検索する。

サンプル

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。