{
  "resourceType": "StructureDefinition",
  "meta": {
    "lastUpdated": "2022-11-08T10:46:36.3860422+00:00"
  },
  "url": "https://hl7.pt/fhir/StructureDefinition/PT_Coverage",
  "version": "1.1",
  "name": "PT_Coverage",
  "status": "draft",
  "experimental": false,
  "date": "2022-11-08T10:47:34.3124993+00:00",
  "description": "A generic Coverage resource for Portugal",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Coverage",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Coverage.meta",
        "path": "Coverage.meta"
      },
      {
        "id": "Coverage.meta.id",
        "path": "Coverage.meta.id",
        "max": "0"
      },
      {
        "id": "Coverage.meta.versionId",
        "path": "Coverage.meta.versionId",
        "max": "0"
      },
      {
        "id": "Coverage.meta.source",
        "path": "Coverage.meta.source",
        "max": "0"
      },
      {
        "id": "Coverage.meta.profile",
        "path": "Coverage.meta.profile",
        "max": "0"
      },
      {
        "id": "Coverage.meta.security",
        "path": "Coverage.meta.security",
        "max": "0"
      },
      {
        "id": "Coverage.meta.tag",
        "path": "Coverage.meta.tag",
        "max": "0"
      },
      {
        "id": "Coverage.implicitRules",
        "path": "Coverage.implicitRules",
        "max": "0"
      },
      {
        "id": "Coverage.language",
        "path": "Coverage.language",
        "max": "0"
      },
      {
        "id": "Coverage.text",
        "path": "Coverage.text",
        "max": "0"
      },
      {
        "id": "Coverage.contained",
        "path": "Coverage.contained",
        "max": "0"
      },
      {
        "id": "Coverage.extension",
        "path": "Coverage.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "open"
        },
        "min": 0
      },
      {
        "id": "Coverage.extension:EconomicInsufficiency",
        "path": "Coverage.extension",
        "sliceName": "EconomicInsufficiency",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://hl7.pt/fhir/StructureDefinition/EconomicInsufficiency"
            ]
          }
        ]
      },
      {
        "id": "Coverage.identifier",
        "path": "Coverage.identifier",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-2"
          }
        ]
      },
      {
        "id": "Coverage.identifier.id",
        "path": "Coverage.identifier.id",
        "max": "0"
      },
      {
        "id": "Coverage.identifier.type",
        "path": "Coverage.identifier.type",
        "max": "0"
      },
      {
        "id": "Coverage.identifier.system",
        "path": "Coverage.identifier.system",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-2.3"
          }
        ]
      },
      {
        "id": "Coverage.identifier.value",
        "path": "Coverage.identifier.value",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-2.1"
          }
        ]
      },
      {
        "id": "Coverage.identifier.period",
        "path": "Coverage.identifier.period",
        "max": "0"
      },
      {
        "id": "Coverage.identifier.assigner.id",
        "path": "Coverage.identifier.assigner.id",
        "max": "0"
      },
      {
        "id": "Coverage.identifier.assigner.reference",
        "path": "Coverage.identifier.assigner.reference",
        "max": "0"
      },
      {
        "id": "Coverage.identifier.assigner.type",
        "path": "Coverage.identifier.assigner.type",
        "max": "0"
      },
      {
        "id": "Coverage.identifier.assigner.identifier",
        "path": "Coverage.identifier.assigner.identifier",
        "max": "0"
      },
      {
        "id": "Coverage.status",
        "path": "Coverage.status",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-45, but if this HL7 field is not sent, pay attention to the period element. When you only have period.start, should be \"active\". When it has passed (period.end), should be \"cancelled\"."
          }
        ]
      },
      {
        "id": "Coverage.type",
        "path": "Coverage.type",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-15"
          }
        ]
      },
      {
        "id": "Coverage.type.id",
        "path": "Coverage.type.id",
        "max": "0"
      },
      {
        "id": "Coverage.type.coding.id",
        "path": "Coverage.type.coding.id",
        "max": "0"
      },
      {
        "id": "Coverage.type.coding.version",
        "path": "Coverage.type.coding.version",
        "max": "0"
      },
      {
        "id": "Coverage.type.coding.code",
        "path": "Coverage.type.coding.code",
        "example": [
          {
            "label": "Code Example 1",
            "valueCode": "EHCPOL"
          },
          {
            "label": "Code Example 2",
            "valueCode": "SUBSIDIZ"
          }
        ],
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-15.1"
          }
        ]
      },
      {
        "id": "Coverage.type.coding.display",
        "path": "Coverage.type.coding.display",
        "example": [
          {
            "label": "Display Example 1",
            "valueString": "Extended Healthcare"
          },
          {
            "label": "Display Example 2",
            "valueString": "Subsidized Health Program"
          }
        ]
      },
      {
        "id": "Coverage.type.coding.userSelected",
        "path": "Coverage.type.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Coverage.type.text",
        "path": "Coverage.type.text",
        "example": [
          {
            "label": "Text Example 1",
            "valueString": "Apólice de Seguro Privado"
          },
          {
            "label": "Text Example 2",
            "valueString": "Programa de Saúde do Governo"
          }
        ]
      },
      {
        "id": "Coverage.policyHolder",
        "path": "Coverage.policyHolder",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://hl7.pt/fhir/StructureDefinition/PT_Patient",
              "https://hl7.pt/fhir/StructureDefinition/PT_RelatedPerson",
              "https://hl7.pt/fhir/StructureDefinition/PT_Organization"
            ]
          }
        ]
      },
      {
        "id": "Coverage.policyHolder.id",
        "path": "Coverage.policyHolder.id",
        "max": "0"
      },
      {
        "id": "Coverage.policyHolder.reference",
        "path": "Coverage.policyHolder.reference",
        "max": "0"
      },
      {
        "id": "Coverage.policyHolder.type",
        "path": "Coverage.policyHolder.type",
        "max": "0"
      },
      {
        "id": "Coverage.policyHolder.identifier",
        "path": "Coverage.policyHolder.identifier",
        "max": "0"
      },
      {
        "id": "Coverage.policyHolder.display",
        "path": "Coverage.policyHolder.display",
        "mapping": [
          {
            "identity": "HL7v2.x-Patient",
            "map": "Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO"
          },
          {
            "identity": "HL7v2.x-RelatedPerson",
            "map": "RelatedPerson/NK1-33.1"
          },
          {
            "identity": "HL7v2.x-Organization",
            "map": "Organization/IN1-3.1; IN2-25; [ORG-2.1; MSH-6; ORC-17.1; ORC-21.3 or ORC-21.10]"
          }
        ]
      },
      {
        "id": "Coverage.subscriber",
        "path": "Coverage.subscriber",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://hl7.pt/fhir/StructureDefinition/PT_Patient",
              "https://hl7.pt/fhir/StructureDefinition/PT_RelatedPerson"
            ]
          }
        ]
      },
      {
        "id": "Coverage.subscriber.id",
        "path": "Coverage.subscriber.id",
        "max": "0"
      },
      {
        "id": "Coverage.subscriber.reference",
        "path": "Coverage.subscriber.reference",
        "max": "0"
      },
      {
        "id": "Coverage.subscriber.type",
        "path": "Coverage.subscriber.type",
        "max": "0"
      },
      {
        "id": "Coverage.subscriber.identifier",
        "path": "Coverage.subscriber.identifier",
        "max": "0"
      },
      {
        "id": "Coverage.subscriber.display",
        "path": "Coverage.subscriber.display",
        "mapping": [
          {
            "identity": "HL7v2.x-Patient",
            "map": "Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO"
          },
          {
            "identity": "HL7v2.x-RelatedPerson",
            "map": "RelatedPerson/NK1-33.1"
          }
        ]
      },
      {
        "id": "Coverage.beneficiary",
        "path": "Coverage.beneficiary",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://hl7.pt/fhir/StructureDefinition/PT_Patient"
            ]
          }
        ]
      },
      {
        "id": "Coverage.beneficiary.id",
        "path": "Coverage.beneficiary.id",
        "max": "0"
      },
      {
        "id": "Coverage.beneficiary.type",
        "path": "Coverage.beneficiary.type",
        "max": "0"
      },
      {
        "id": "Coverage.beneficiary.identifier",
        "path": "Coverage.beneficiary.identifier",
        "max": "0"
      },
      {
        "id": "Coverage.beneficiary.display",
        "path": "Coverage.beneficiary.display",
        "max": "0",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO"
          }
        ]
      },
      {
        "id": "Coverage.dependent",
        "path": "Coverage.dependent",
        "max": "0"
      },
      {
        "id": "Coverage.relationship.id",
        "path": "Coverage.relationship.id",
        "max": "0"
      },
      {
        "id": "Coverage.relationship.coding.id",
        "path": "Coverage.relationship.coding.id",
        "max": "0"
      },
      {
        "id": "Coverage.relationship.coding.system",
        "path": "Coverage.relationship.coding.system",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-17.3"
          }
        ]
      },
      {
        "id": "Coverage.relationship.coding.version",
        "path": "Coverage.relationship.coding.version",
        "max": "0"
      },
      {
        "id": "Coverage.relationship.coding.code",
        "path": "Coverage.relationship.coding.code",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-17.1"
          }
        ]
      },
      {
        "id": "Coverage.relationship.coding.display",
        "path": "Coverage.relationship.coding.display",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-17.2"
          }
        ]
      },
      {
        "id": "Coverage.relationship.coding.userSelected",
        "path": "Coverage.relationship.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Coverage.relationship.text",
        "path": "Coverage.relationship.text",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "Translation to [PT] of the display field"
          }
        ]
      },
      {
        "id": "Coverage.period.id",
        "path": "Coverage.period.id",
        "max": "0"
      },
      {
        "id": "Coverage.period.start",
        "path": "Coverage.period.start",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-12"
          }
        ]
      },
      {
        "id": "Coverage.period.end",
        "path": "Coverage.period.end",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-13"
          }
        ]
      },
      {
        "id": "Coverage.payor",
        "path": "Coverage.payor",
        "definition": "The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.\r\nPT - it is necessary to create a list of responsible entities ​​for a correct mapping",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://hl7.pt/fhir/StructureDefinition/PT_Organization",
              "https://hl7.pt/fhir/StructureDefinition/PT_RelatedPerson",
              "https://hl7.pt/fhir/StructureDefinition/PT_Patient"
            ]
          }
        ]
      },
      {
        "id": "Coverage.payor.id",
        "path": "Coverage.payor.id",
        "max": "0"
      },
      {
        "id": "Coverage.payor.type",
        "path": "Coverage.payor.type",
        "max": "0"
      },
      {
        "id": "Coverage.payor.identifier",
        "path": "Coverage.payor.identifier",
        "max": "0"
      },
      {
        "id": "Coverage.payor.display",
        "path": "Coverage.payor.display",
        "max": "0",
        "mapping": [
          {
            "identity": "HL7v2.x-Organization",
            "map": "Organization/IN1-3.1; IN2-25"
          },
          {
            "identity": "HL7v2.x-RelatedPerson",
            "map": "RelatedPerson/NK1-33.1"
          },
          {
            "identity": "HL7v2.x-Patient",
            "map": "Patient/PID-3 c/ SNS; PID-18.1; PID-3 c/ SONHO"
          }
        ]
      },
      {
        "id": "Coverage.class",
        "path": "Coverage.class",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "ZID-2; ZID-3; ZID-6"
          }
        ]
      },
      {
        "id": "Coverage.class.id",
        "path": "Coverage.class.id",
        "max": "0"
      },
      {
        "id": "Coverage.class.type.id",
        "path": "Coverage.class.type.id",
        "max": "0"
      },
      {
        "id": "Coverage.class.type.coding.id",
        "path": "Coverage.class.type.coding.id",
        "max": "0"
      },
      {
        "id": "Coverage.class.type.coding.system",
        "path": "Coverage.class.type.coding.system",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "ZID-2.3; ZID-3.3; ZID-6.3"
          }
        ]
      },
      {
        "id": "Coverage.class.type.coding.version",
        "path": "Coverage.class.type.coding.version",
        "max": "0"
      },
      {
        "id": "Coverage.class.type.coding.code",
        "path": "Coverage.class.type.coding.code",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "ZID-2.1; ZID-3.1; ZID-6.1"
          }
        ]
      },
      {
        "id": "Coverage.class.type.coding.display",
        "path": "Coverage.class.type.coding.display",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "ZID-2.2; ZID-3.2; ZID-6.2"
          }
        ]
      },
      {
        "id": "Coverage.class.type.coding.userSelected",
        "path": "Coverage.class.type.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Coverage.class.type.text",
        "path": "Coverage.class.type.text",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "if necessary - Translation to [PT] of the display field"
          }
        ]
      },
      {
        "id": "Coverage.class.value",
        "path": "Coverage.class.value",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "ZID-2.4; ZID-3.4; ZID-6.4"
          }
        ]
      },
      {
        "id": "Coverage.class.name",
        "path": "Coverage.class.name",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "ZID-2.5; ZID-3.5; ZID-6.5"
          }
        ]
      },
      {
        "id": "Coverage.order",
        "path": "Coverage.order",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-1 = 1 (priority)"
          }
        ]
      },
      {
        "id": "Coverage.network",
        "path": "Coverage.network",
        "max": "0"
      },
      {
        "id": "Coverage.costToBeneficiary",
        "path": "Coverage.costToBeneficiary",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-37"
          }
        ]
      },
      {
        "id": "Coverage.costToBeneficiary.id",
        "path": "Coverage.costToBeneficiary.id",
        "max": "0"
      },
      {
        "id": "Coverage.costToBeneficiary.type",
        "path": "Coverage.costToBeneficiary.type",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-37.2"
          }
        ]
      },
      {
        "id": "Coverage.costToBeneficiary.type.id",
        "path": "Coverage.costToBeneficiary.type.id",
        "max": "0"
      },
      {
        "id": "Coverage.costToBeneficiary.type.coding.id",
        "path": "Coverage.costToBeneficiary.type.coding.id",
        "max": "0"
      },
      {
        "id": "Coverage.costToBeneficiary.type.coding.version",
        "path": "Coverage.costToBeneficiary.type.coding.version",
        "max": "0"
      },
      {
        "id": "Coverage.costToBeneficiary.type.coding.code",
        "path": "Coverage.costToBeneficiary.type.coding.code",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-37.2.1"
          }
        ]
      },
      {
        "id": "Coverage.costToBeneficiary.type.coding.userSelected",
        "path": "Coverage.costToBeneficiary.type.coding.userSelected",
        "max": "0"
      },
      {
        "id": "Coverage.costToBeneficiary.value[x]",
        "path": "Coverage.costToBeneficiary.value[x]",
        "mapping": [
          {
            "identity": "HL7v2.x",
            "map": "IN1-37.1.1"
          }
        ]
      },
      {
        "id": "Coverage.subrogation",
        "path": "Coverage.subrogation",
        "max": "0"
      }
    ]
  }
}