AU eRequesting Implementation Guide
0.2.0-preview - Preview
AU eRequesting Implementation Guide
0.2.0-preview - Preview
This page is part of the AU eRequesting (v0.2.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions
| Page standards status: Draft | Maturity Level: 0 |
XML representation of the au-erequesting-coverage resource profile.
<StructureDefinition xmlns="http://hl7.org/fhir">
<id value="au-erequesting-coverage"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition au-erequesting-coverage</b></p><a name="au-erequesting-coverage"> </a><a name="hcau-erequesting-coverage"> </a><a name="au-erequesting-coverage-en-AU"> </a><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Minimum and Maximum # of times the element can appear in the instance">Card.</a></th><th style="width: 100px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Additional information about the element">Description & Constraints</a><span style="float: right"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-au-erequesting-coverage-definitions.html#Coverage">Coverage</a><a name="Coverage"> </a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org.au/fhir/4.2.2-preview/StructureDefinition-au-coverage.html">AUBaseCoverage</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Insurance or medical plan or a payment agreement</span></td></tr>
<tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-au-erequesting-coverage-definitions.html#Coverage.type">type</a><a name="Coverage.type"> </a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">Coverage category such as medical or accident</span><br/><span style="font-weight:bold">Binding: </span><a href="http://hl7.org/fhir/R4/valueset-coverage-type.html" title="http://hl7.org/fhir/ValueSet/coverage-type">CoverageTypeAndSelf-PayCodes</a> (<a href="http://hl7.org/fhir/R4/terminologies.html#preferred" title="Instances are encouraged to draw from the specified codes for interoperability purposes but are not required to do so to be considered conformant.">preferred</a>)<table class="grid"><tr><td style="font-size: 11px"><b>Additional Bindings</b></td><td style="font-size: 11px">Purpose</td></tr><tr><td style="font-size: 11px"><a href="ValueSet-au-erequesting-coverage-type.html" title="http://hl7.org.au/fhir/ereq/ValueSet/au-erequesting-coverage-type">AU eRequesting Coverage Type and Self-Pay Codes</a></td><td style="font-size: 11px"><a href="http://hl7.org/fhir/R4/extension-elementdefinition-minvalueset.html" title="The minimum allowable value set - any conformant system SHALL support all these codes">Min Binding</a></td></tr></table></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="0"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="draft">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org.au/fhir/ereq/ImplementationGuide/hl7.fhir.au.ereq"/>
</extension>
</valueCode>
</extension>
<url
value="http://hl7.org.au/fhir/ereq/StructureDefinition/au-erequesting-coverage"/>
<version value="0.2.0-preview"/>
<name value="AUeRequestingCoverage"/>
<title value="AU eRequesting Coverage"/>
<status value="draft"/>
<date value="2024-12-05T09:17:10+00:00"/>
<publisher value="HL7 Australia"/>
<contact>
<name value="HL7 Australia"/>
<telecom>
<system value="url"/>
<value value="https://confluence.hl7.org/display/HAFWG"/>
</telecom>
</contact>
<contact>
<name value="HL7 Australia FHIR Work Group"/>
<telecom>
<system value="url"/>
<value value="https://confluence.hl7.org/display/HAFWG"/>
<use value="work"/>
</telecom>
</contact>
<description
value="This profile sets minimum expectations for a Coverage resource that is used to record, search, and fetch information about insurance or medical plan or a payment agreement for a patient. It is based on the [AU Base Coverage](https://build.fhir.org/ig/hl7au/au-fhir-base/StructureDefinition-au-coverage.html) and identifies the additional constraints, extensions, vocabularies and value sets that **SHALL** be present in the Coverage when conforming to this profile."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="AU"/>
</coding>
</jurisdiction>
<copyright
value="Used by permission of HL7 International, all rights reserved Creative Commons License. HL7 Australia© 2024+; Licensed Under Creative Commons No Rights Reserved."/>
<fhirVersion value="4.0.1"/>
<mapping>
<identity value="workflow"/>
<uri value="http://hl7.org/fhir/workflow"/>
<name value="Workflow Pattern"/>
</mapping>
<mapping>
<identity value="rim"/>
<uri value="http://hl7.org/v3"/>
<name value="RIM Mapping"/>
</mapping>
<mapping>
<identity value="w5"/>
<uri value="http://hl7.org/fhir/fivews"/>
<name value="FiveWs Pattern Mapping"/>
</mapping>
<mapping>
<identity value="cdanetv4"/>
<uri value="http://www.cda-adc.ca/en/services/cdanet/"/>
<name value="Canadian Dental Association eclaims standard"/>
</mapping>
<mapping>
<identity value="v2"/>
<uri value="http://hl7.org/v2"/>
<name value="HL7 v2 Mapping"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<uri value="http://www.pharmacists.ca/"/>
<name value="Canadian Pharmacy Associaiton eclaims standard"/>
</mapping>
<kind value="resource"/>
<abstract value="false"/>
<type value="Coverage"/>
<baseDefinition
value="http://hl7.org.au/fhir/StructureDefinition/au-coverage"/>
<derivation value="constraint"/>
<snapshot>
<element id="Coverage">
<path value="Coverage"/>
<short value="Insurance or medical plan or a payment agreement"/>
<definition
value="Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment."/>
<comment
value="The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Coverage"/>
<min value="0"/>
<max value="*"/>
</base>
<constraint>
<key value="dom-2"/>
<severity value="error"/>
<human
value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
<expression value="contained.contained.empty()"/>
<xpath value="not(parent::f:contained and f:contained)"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<key value="dom-3"/>
<severity value="error"/>
<human
value="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"/>
<expression
value="contained.where((('#'+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(canonical) = '#').exists()).not()).trace('unmatched', id).empty()"/>
<xpath
value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<key value="dom-4"/>
<severity value="error"/>
<human
value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
<expression
value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
<xpath
value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<key value="dom-5"/>
<severity value="error"/>
<human
value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
<expression value="contained.meta.security.empty()"/>
<xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<constraint>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
<valueBoolean value="true"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown
value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
</extension>
<key value="dom-6"/>
<severity value="warning"/>
<human
value="A resource should have narrative for robust management"/>
<expression value="text.`div`.exists()"/>
<xpath value="exists(f:text/h:div)"/>
<source
value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="Entity. Role, or Act"/>
</mapping>
<mapping>
<identity value="workflow"/>
<map value="Event"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="Coverage"/>
</mapping>
</element>
<element id="Coverage.id">
<path value="Coverage.id"/>
<short value="Logical id of this artifact"/>
<definition
value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
<comment
value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Resource.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="id"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="Coverage.meta">
<path value="Coverage.meta"/>
<short value="Metadata about the resource"/>
<definition
value="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."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Resource.meta"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Meta"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="Coverage.implicitRules">
<path value="Coverage.implicitRules"/>
<short value="A set of rules under which this content was created"/>
<definition
value="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."/>
<comment
value="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."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Resource.implicitRules"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="uri"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="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"/>
<isSummary value="true"/>
</element>
<element id="Coverage.language">
<path value="Coverage.language"/>
<short value="Language of the resource content"/>
<definition
value="The base language in which the resource is written."/>
<comment
value="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)."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Resource.language"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language"/>
</extension>
<strength value="preferred"/>
<description value="A human language."/>
<valueSet value="http://hl7.org/fhir/ValueSet/languages"/>
</binding>
</element>
<element id="Coverage.text">
<path value="Coverage.text"/>
<short value="Text summary of the resource, for human interpretation"/>
<definition
value="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."/>
<comment
value="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."/>
<alias value="narrative"/>
<alias value="html"/>
<alias value="xhtml"/>
<alias value="display"/>
<min value="0"/>
<max value="1"/>
<base>
<path value="DomainResource.text"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Narrative"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="Act.text?"/>
</mapping>
</element>
<element id="Coverage.contained">
<path value="Coverage.contained"/>
<short value="Contained, inline Resources"/>
<definition
value="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."/>
<comment
value="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."/>
<alias value="inline resources"/>
<alias value="anonymous resources"/>
<alias value="contained resources"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="DomainResource.contained"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Resource"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="Coverage.extension">
<path value="Coverage.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="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."/>
<comment
value="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."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="DomainResource.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="Coverage.modifierExtension">
<path value="Coverage.modifierExtension"/>
<short value="Extensions that cannot be ignored"/>
<definition
value="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)."/>
<comment
value="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."/>
<requirements
value="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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="DomainResource.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="Coverage.identifier">
<path value="Coverage.identifier"/>
<short value="An identifier intended for computation"/>
<definition
value="An identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers."/>
<comment
value="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."/>
<requirements
value="Allows coverages to be distinguished and referenced."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Coverage.identifier"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Identifier"/>
<profile value="http://hl7.org/fhir/StructureDefinition/Identifier"/>
<profile
value="http://hl7.org.au/fhir/StructureDefinition/au-medicarecardnumber"/>
<profile
value="http://hl7.org.au/fhir/StructureDefinition/au-dvanumber"/>
<profile
value="http://hl7.org.au/fhir/StructureDefinition/au-insurancemembernumber"/>
<profile
value="http://hl7.org.au/fhir/StructureDefinition/au-pensionerconcessioncardnumber"/>
<profile
value="http://hl7.org.au/fhir/StructureDefinition/au-cwlthseniorshealthcardnumber"/>
<profile
value="http://hl7.org.au/fhir/StructureDefinition/au-healthcarecardnumber"/>
</type>
<condition value="ele-1"/>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
<mapping>
<identity value="v2"/>
<map
value="CX / EI (occasionally, more often EI maps to a resource id or a URL)"/>
</mapping>
<mapping>
<identity value="rim"/>
<map
value="II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]"/>
</mapping>
<mapping>
<identity value="servd"/>
<map value="Identifier"/>
</mapping>
</element>
<element id="Coverage.status">
<path value="Coverage.status"/>
<short value="active | cancelled | draft | entered-in-error"/>
<definition value="The status of the resource instance."/>
<comment
value="This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid."/>
<requirements
value="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'."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Coverage.status"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="code"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="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"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="CoverageStatus"/>
</extension>
<strength value="required"/>
<description
value="A code specifying the state of the resource instance."/>
<valueSet value="http://hl7.org/fhir/ValueSet/fm-status|4.0.1"/>
</binding>
<mapping>
<identity value="workflow"/>
<map value="Event.status"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.status"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="Act.status"/>
</mapping>
</element>
<element id="Coverage.type">
<path value="Coverage.type"/>
<short value="Coverage category such as medical or accident"/>
<definition
value="The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization."/>
<requirements
value="The order of application of coverages is dependent on the types of coverage."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.type"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="minimum"/>
</extension>
<extension url="valueSet">
<valueCanonical
value="http://hl7.org.au/fhir/ereq/ValueSet/au-erequesting-coverage-type"/>
</extension>
<extension url="documentation">
<valueMarkdown
value="The minimum set of codes that any conformant system SHALL support."/>
</extension>
</extension>
<strength value="preferred"/>
<valueSet value="http://hl7.org/fhir/ValueSet/coverage-type"/>
</binding>
<mapping>
<identity value="w5"/>
<map value="FiveWs.class"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-15"/>
</mapping>
</element>
<element id="Coverage.policyHolder">
<path value="Coverage.policyHolder"/>
<short value="Owner of the policy"/>
<definition value="The party who 'owns' the insurance policy."/>
<comment
value="For example: may be an individual, corporation or the subscriber's employer."/>
<requirements
value="This provides employer information in the case of Worker's Compensation and other policies."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.policyHolder"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Patient"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Organization"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject[x]"/>
</mapping>
<mapping>
<identity value="cdanetv4"/>
<map value="D01 through D09"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-16, 18, 19-name of insured, address, date of birth"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.35"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject"/>
</mapping>
</element>
<element id="Coverage.subscriber">
<path value="Coverage.subscriber"/>
<short value="Subscriber to the policy"/>
<definition
value="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."/>
<comment value="May be self or a parent in the case of dependants."/>
<requirements
value="This is the party who is entitled to the benfits under the policy."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.subscriber"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Patient"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject[x]"/>
</mapping>
<mapping>
<identity value="cdanetv4"/>
<map value="D01 through D09"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-16, 18, 19-name of insured, address, date of birth"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.35"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject"/>
</mapping>
</element>
<element id="Coverage.subscriberId">
<path value="Coverage.subscriberId"/>
<short value="ID assigned to the subscriber"/>
<definition value="The insurer assigned ID for the Subscriber."/>
<requirements
value="The insurer requires this identifier on correspondance and claims (digital and otherwise)."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.subscriberId"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject[x]"/>
</mapping>
<mapping>
<identity value="cdanetv4"/>
<map value="D01 through D09"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-16, 18, 19-name of insured, address, date of birth"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.35"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject"/>
</mapping>
</element>
<element id="Coverage.beneficiary">
<path value="Coverage.beneficiary"/>
<short value="Plan beneficiary"/>
<definition
value="The party who benefits from the insurance coverage; the patient when products and/or services are provided."/>
<requirements
value="This is the party who receives treatment for which the costs are reimbursed under the coverage."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Coverage.beneficiary"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Patient"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="workflow"/>
<map value="Event.subject"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject[x]"/>
</mapping>
<mapping>
<identity value="cdanetv4"/>
<map value="D01 through D09"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-16, 18, 19-name of insured, address, date of birth"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.35"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.subject"/>
</mapping>
</element>
<element id="Coverage.dependent">
<path value="Coverage.dependent"/>
<short value="Dependent number"/>
<definition
value="A unique identifier for a dependent under the coverage."/>
<comment
value="Periodically the member number is constructed from the subscriberId and the dependant number."/>
<requirements
value="For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.dependent"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="cdanetv4"/>
<map value="C17"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="- No exact HL7 v2 equivalent concept seems to exist;"/>
</mapping>
</element>
<element id="Coverage.relationship">
<path value="Coverage.relationship"/>
<short value="Beneficiary relationship to the subscriber"/>
<definition
value="The relationship of beneficiary (patient) to the subscriber."/>
<comment
value="Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others."/>
<requirements
value="To determine relationship between the patient and the subscriber to determine coordination of benefits."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.relationship"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Relationship"/>
</extension>
<strength value="extensible"/>
<description
value="The relationship between the Subscriber and the Beneficiary (insured/covered party/patient)."/>
<valueSet
value="http://hl7.org/fhir/ValueSet/subscriber-relationship"/>
</binding>
<mapping>
<identity value="cdanetv4"/>
<map value="C03"/>
</mapping>
</element>
<element id="Coverage.period">
<path value="Coverage.period"/>
<short value="Coverage start and end dates"/>
<definition
value="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."/>
<requirements
value="Some insurers require the submission of the coverage term."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.period"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="workflow"/>
<map value="Event.occurrence[x]"/>
</mapping>
<mapping>
<identity value="w5"/>
<map value="FiveWs.done[x]"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-12 / IN1-13"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="Act.effectiveTime"/>
</mapping>
</element>
<element id="Coverage.payor">
<path value="Coverage.payor"/>
<short value="Issuer of the policy"/>
<definition
value="The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements."/>
<comment
value="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."/>
<requirements
value="Need to identify the issuer to target for claim processing and for coordination of benefit processing."/>
<min value="1"/>
<max value="*"/>
<base>
<path value="Coverage.payor"/>
<min value="1"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Organization"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Patient"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="w5"/>
<map value="FiveWs.author"/>
</mapping>
<mapping>
<identity value="cdanetv4"/>
<map value="A05"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-3"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.30"/>
</mapping>
</element>
<element id="Coverage.class">
<path value="Coverage.class"/>
<short value="Additional coverage classifications"/>
<definition value="A suite of underwriter specific classifiers."/>
<comment
value="For example may be used to identify a class of coverage or employer group, Policy, Plan."/>
<requirements
value="The codes provided on the health card which identify or confirm the specific policy for the insurer."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Coverage.class"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="Coverage.class.id">
<path value="Coverage.class.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="Coverage.class.extension">
<path value="Coverage.class.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="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."/>
<comment
value="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."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="Coverage.class.modifierExtension">
<path value="Coverage.class.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="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)."/>
<comment
value="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."/>
<requirements
value="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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="Coverage.class.type">
<path value="Coverage.class.type"/>
<short value="Type of class such as 'group' or 'plan'"/>
<definition
value="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."/>
<requirements
value="The insurer issued label for a specific health card value."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Coverage.class.type"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="CoverageClass"/>
</extension>
<strength value="extensible"/>
<description
value="The policy classifications, eg. Group, Plan, Class, etc."/>
<valueSet value="http://hl7.org/fhir/ValueSet/coverage-class"/>
</binding>
</element>
<element id="Coverage.class.value">
<path value="Coverage.class.value"/>
<short value="Value associated with the type"/>
<definition
value="The alphanumeric string value associated with the insurer issued label."/>
<comment value="For example, the Group or Plan number."/>
<requirements
value="The insurer issued label and value are necessary to identify the specific policy."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Coverage.class.value"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="cdanetv4"/>
<map value="C11 (Division,Section)"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-8"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.31"/>
</mapping>
</element>
<element id="Coverage.class.name">
<path value="Coverage.class.name"/>
<short value="Human readable description of the type and value"/>
<definition value="A short description for the class."/>
<requirements
value="Used to provide a meaningful description in correspondence to the patient."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.class.name"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="cdanetv4"/>
<map value="C11 (Division,Section)"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-8"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.31"/>
</mapping>
</element>
<element id="Coverage.order">
<path value="Coverage.order"/>
<short value="Relative order of the coverage"/>
<definition
value="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."/>
<requirements value="Used in managing the coordination of benefits."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.order"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="positiveInt"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="v2"/>
<map value="- No exact HL7 v2 equivalent concept seems to exist;"/>
</mapping>
</element>
<element id="Coverage.network">
<path value="Coverage.network"/>
<short value="Insurer network"/>
<definition
value="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."/>
<requirements
value="Used in referral for treatment and in claims processing."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.network"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="string"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="cdanetv4"/>
<map value="D10"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary">
<path value="Coverage.costToBeneficiary"/>
<short value="Patient payments for services/products"/>
<definition
value="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."/>
<comment
value="For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment."/>
<requirements
value="Required by providers to manage financial transaction with the patient."/>
<alias value="CoPay"/>
<alias value="Deductible"/>
<alias value="Exceptions"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Coverage.costToBeneficiary"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="Coverage.costToBeneficiary.id">
<path value="Coverage.costToBeneficiary.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary.extension">
<path value="Coverage.costToBeneficiary.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="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."/>
<comment
value="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."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary.modifierExtension">
<path value="Coverage.costToBeneficiary.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="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)."/>
<comment
value="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."/>
<requirements
value="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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary.type">
<path value="Coverage.costToBeneficiary.type"/>
<short value="Cost category"/>
<definition
value="The category of patient centric costs associated with treatment."/>
<comment
value="For example visit, specialist visits, emergency, inpatient care, etc."/>
<requirements
value="Needed to identify the category associated with the amount for the patient."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.costToBeneficiary.type"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="CopayTypes"/>
</extension>
<strength value="extensible"/>
<description
value="The types of services to which patient copayments are specified."/>
<valueSet value="http://hl7.org/fhir/ValueSet/coverage-copay-type"/>
</binding>
</element>
<element id="Coverage.costToBeneficiary.value[x]">
<path value="Coverage.costToBeneficiary.value[x]"/>
<short value="The amount or percentage due from the beneficiary"/>
<definition
value="The amount due from the patient for the cost category."/>
<comment
value="Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency."/>
<requirements
value="Needed to identify the amount for the patient associated with the category."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Coverage.costToBeneficiary.value[x]"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="Quantity"/>
<profile
value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity"/>
</type>
<type>
<code value="Money"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<mapping>
<identity value="cdanetv4"/>
<map value="C11 (Division,Section)"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-8"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.31"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary.exception">
<path value="Coverage.costToBeneficiary.exception"/>
<short value="Exceptions for patient payments"/>
<definition
value="A suite of codes indicating exceptions or reductions to patient costs and their effective periods."/>
<requirements
value="Required by providers to manage financial transaction with the patient."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Coverage.costToBeneficiary.exception"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="BackboneElement"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="Coverage.costToBeneficiary.exception.id">
<path value="Coverage.costToBeneficiary.exception.id"/>
<representation value="xmlAttr"/>
<short value="Unique id for inter-element referencing"/>
<definition
value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Element.id"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string"/>
</extension>
<code value="http://hl7.org/fhirpath/System.String"/>
</type>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary.exception.extension">
<path value="Coverage.costToBeneficiary.exception.extension"/>
<short value="Additional content defined by implementations"/>
<definition
value="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."/>
<comment
value="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."/>
<alias value="extensions"/>
<alias value="user content"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Element.extension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary.exception.modifierExtension">
<path value="Coverage.costToBeneficiary.exception.modifierExtension"/>
<short value="Extensions that cannot be ignored even if unrecognized"/>
<definition
value="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)."/>
<comment
value="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."/>
<requirements
value="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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
<alias value="extensions"/>
<alias value="user content"/>
<alias value="modifiers"/>
<min value="0"/>
<max value="*"/>
<base>
<path value="BackboneElement.modifierExtension"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Extension"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<constraint>
<key value="ext-1"/>
<severity value="error"/>
<human value="Must have either extensions or value[x], not both"/>
<expression value="extension.exists() != value.exists()"/>
<xpath
value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])"/>
<source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
</constraint>
<isModifier value="true"/>
<isModifierReason
value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
<isSummary value="true"/>
<mapping>
<identity value="rim"/>
<map value="N/A"/>
</mapping>
</element>
<element id="Coverage.costToBeneficiary.exception.type">
<path value="Coverage.costToBeneficiary.exception.type"/>
<short value="Exception category"/>
<definition value="The code for the specific exception."/>
<requirements
value="Needed to identify the exception associated with the amount for the patient."/>
<min value="1"/>
<max value="1"/>
<base>
<path value="Coverage.costToBeneficiary.exception.type"/>
<min value="1"/>
<max value="1"/>
</base>
<type>
<code value="CodeableConcept"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
<binding>
<extension
url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="CoverageFinancialException"/>
</extension>
<strength value="example"/>
<description
value="The types of exceptions from the part or full value of financial obligations such as copays."/>
<valueSet
value="http://hl7.org/fhir/ValueSet/coverage-financial-exception"/>
</binding>
</element>
<element id="Coverage.costToBeneficiary.exception.period">
<path value="Coverage.costToBeneficiary.exception.period"/>
<short value="The effective period of the exception"/>
<definition
value="The timeframe during when the exception is in force."/>
<requirements
value="Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.costToBeneficiary.exception.period"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="Period"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="true"/>
</element>
<element id="Coverage.subrogation">
<path value="Coverage.subrogation"/>
<short value="Reimbursement to insurer"/>
<definition
value="When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs."/>
<comment
value="Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims."/>
<requirements value="See definition for when to be used."/>
<min value="0"/>
<max value="1"/>
<base>
<path value="Coverage.subrogation"/>
<min value="0"/>
<max value="1"/>
</base>
<type>
<code value="boolean"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
</element>
<element id="Coverage.contract">
<path value="Coverage.contract"/>
<short value="Contract details"/>
<definition
value="The policy(s) which constitute this insurance coverage."/>
<requirements
value="To reference the legally binding contract between the policy holder and the insurer."/>
<min value="0"/>
<max value="*"/>
<base>
<path value="Coverage.contract"/>
<min value="0"/>
<max value="*"/>
</base>
<type>
<code value="Reference"/>
<targetProfile
value="http://hl7.org/fhir/StructureDefinition/Contract"/>
</type>
<constraint>
<key value="ele-1"/>
<severity value="error"/>
<human value="All FHIR elements must have a @value or children"/>
<expression
value="hasValue() or (children().count() > id.count())"/>
<xpath value="@value|f:*|h:div"/>
<source value="http://hl7.org/fhir/StructureDefinition/Element"/>
</constraint>
<isModifier value="false"/>
<isSummary value="false"/>
<mapping>
<identity value="cdanetv4"/>
<map value="D01 through D09"/>
</mapping>
<mapping>
<identity value="v2"/>
<map value="IN1-16, 18, 19"/>
</mapping>
<mapping>
<identity value="rim"/>
<map value="n/a"/>
</mapping>
<mapping>
<identity value="cpha3pharm"/>
<map value="C.35"/>
</mapping>
</element>
</snapshot>
<differential>
<element id="Coverage">
<path value="Coverage"/>
</element>
<element id="Coverage.type">
<path value="Coverage.type"/>
<binding>
<extension
url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="minimum"/>
</extension>
<extension url="valueSet">
<valueCanonical
value="http://hl7.org.au/fhir/ereq/ValueSet/au-erequesting-coverage-type"/>
</extension>
<extension url="documentation">
<valueMarkdown
value="The minimum set of codes that any conformant system SHALL support."/>
</extension>
</extension>
<strength value="preferred"/>
<valueSet value="http://hl7.org/fhir/ValueSet/coverage-type"/>
</binding>
</element>
</differential>
</StructureDefinition>
IG © 2024 HL7 Australia. Package hl7.fhir.au.ereq#0.2.0-preview based on FHIR 4.0.1. Generated 2024-12-05
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