{
  "resourceType": "StructureDefinition",
  "id": "KBV-PR-AW-Leistungsgenehmigung-Heilmittel",
  "url": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Leistungsgenehmigung_Heilmittel",
  "version": "1.3.0",
  "name": "KBV_PR_AW_Leistungsgenehmigung_Heilmittel",
  "status": "draft",
  "publisher": "Kassenärztliche Bundesvereinigung (KBV)",
  "copyright": "Copyright © [2022], Kassenärztliche Bundesvereinigung (KBV). All rights reserved.",
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    },
    {
      "identity": "cdanetv4",
      "uri": "http://www.cda-adc.ca/en/services/cdanet/",
      "name": "Canadian Dental Association eclaims standard"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "CoverageEligibilityResponse",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/CoverageEligibilityResponse",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "CoverageEligibilityResponse.id",
        "path": "CoverageEligibilityResponse.id",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.meta",
        "path": "CoverageEligibilityResponse.meta",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.meta.versionId",
        "path": "CoverageEligibilityResponse.meta.versionId",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.meta.lastUpdated",
        "path": "CoverageEligibilityResponse.meta.lastUpdated",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.meta.profile",
        "path": "CoverageEligibilityResponse.meta.profile",
        "min": 1,
        "max": "1",
        "fixedCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Leistungsgenehmigung_Heilmittel|1.3.0"
      },
      {
        "id": "CoverageEligibilityResponse.text",
        "path": "CoverageEligibilityResponse.text",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.text.status",
        "path": "CoverageEligibilityResponse.text.status",
        "short": "extensions",
        "fixedCode": "extensions"
      },
      {
        "id": "CoverageEligibilityResponse.identifier",
        "path": "CoverageEligibilityResponse.identifier",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.purpose",
        "path": "CoverageEligibilityResponse.purpose",
        "short": "auth-requirements",
        "max": "1",
        "fixedCode": "auth-requirements"
      },
      {
        "id": "CoverageEligibilityResponse.patient",
        "path": "CoverageEligibilityResponse.patient",
        "short": "Patientenbezug",
        "definition": "Patient Resource.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Patient|1.3.0"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.patient.reference",
        "path": "CoverageEligibilityResponse.patient.reference",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.patient.type",
        "path": "CoverageEligibilityResponse.patient.type",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.patient.identifier",
        "path": "CoverageEligibilityResponse.patient.identifier",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.patient.display",
        "path": "CoverageEligibilityResponse.patient.display",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.serviced[x]",
        "path": "CoverageEligibilityResponse.serviced[x]",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.created",
        "path": "CoverageEligibilityResponse.created",
        "short": "Bewilligungsdatum",
        "definition": "Angabe des Datums der Bewilligung",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.requestor",
        "path": "CoverageEligibilityResponse.requestor",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.request",
        "path": "CoverageEligibilityResponse.request",
        "short": "Heilmittelanfrage",
        "definition": "Die Heilmittelgenehmigung basiert immer auf einer Genehmigungsanfrage.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Leistungsanfrage_Heilmittel|1.3.0"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.request.reference",
        "path": "CoverageEligibilityResponse.request.reference",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.request.type",
        "path": "CoverageEligibilityResponse.request.type",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.request.identifier",
        "path": "CoverageEligibilityResponse.request.identifier",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.request.display",
        "path": "CoverageEligibilityResponse.request.display",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.outcome",
        "path": "CoverageEligibilityResponse.outcome",
        "short": "complete",
        "fixedCode": "complete"
      },
      {
        "id": "CoverageEligibilityResponse.insurer",
        "path": "CoverageEligibilityResponse.insurer",
        "short": "Versicherer",
        "definition": "Gibt den Kostentraeger des Versicherten an. Die Angabe der IK-Nummer als logische Referenz sowie des Namend als Display ist zwingend erforderlich. Die Referenz auf eine Resource vom Typ Organization, die weitere Details zur Versicherung enthalten kann (z.B. Adresse, Kontaktdaten) ist optional.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Organisation|1.3.0"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurer.type",
        "path": "CoverageEligibilityResponse.insurer.type",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurer.identifier",
        "path": "CoverageEligibilityResponse.insurer.identifier",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurer.identifier.use",
        "path": "CoverageEligibilityResponse.insurer.identifier.use",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurer.identifier.type",
        "path": "CoverageEligibilityResponse.insurer.identifier.type",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurer.identifier.system",
        "path": "CoverageEligibilityResponse.insurer.identifier.system",
        "min": 1,
        "fixedUri": "http://fhir.de/sid/arge-ik/iknr"
      },
      {
        "id": "CoverageEligibilityResponse.insurer.identifier.value",
        "path": "CoverageEligibilityResponse.insurer.identifier.value",
        "min": 1
      },
      {
        "id": "CoverageEligibilityResponse.insurer.identifier.period",
        "path": "CoverageEligibilityResponse.insurer.identifier.period",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurer.identifier.assigner",
        "path": "CoverageEligibilityResponse.insurer.identifier.assigner",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurer.display",
        "path": "CoverageEligibilityResponse.insurer.display",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance",
        "path": "CoverageEligibilityResponse.insurance",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.coverage",
        "path": "CoverageEligibilityResponse.insurance.coverage",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Krankenversicherungsverhaeltnis|1.3.0"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.coverage.reference",
        "path": "CoverageEligibilityResponse.insurance.coverage.reference",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.coverage.type",
        "path": "CoverageEligibilityResponse.insurance.coverage.type",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.coverage.identifier",
        "path": "CoverageEligibilityResponse.insurance.coverage.identifier",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.coverage.display",
        "path": "CoverageEligibilityResponse.insurance.coverage.display",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.inforce",
        "path": "CoverageEligibilityResponse.insurance.inforce",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.benefitPeriod",
        "path": "CoverageEligibilityResponse.insurance.benefitPeriod",
        "short": "Genehmigungsdatum",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.benefitPeriod.start",
        "path": "CoverageEligibilityResponse.insurance.benefitPeriod.start",
        "definition": "Anzugeben ist das Datum ab der die Genehmigung gültig ist.",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.benefitPeriod.end",
        "path": "CoverageEligibilityResponse.insurance.benefitPeriod.end",
        "short": "Datum",
        "definition": "Anzugeben ist das Datum bis zu dem die Genehmigung gültig ist.",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item",
        "path": "CoverageEligibilityResponse.insurance.item",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.category",
        "path": "CoverageEligibilityResponse.insurance.item.category",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.category.coding",
        "path": "CoverageEligibilityResponse.insurance.item.category.coding",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.category.coding.system",
        "path": "CoverageEligibilityResponse.insurance.item.category.coding.system",
        "min": 1,
        "fixedUri": "https://fhir.kbv.de/CodeSystem/KBV_CS_AW_Eligibility_Kategorie",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.category.coding.code",
        "path": "CoverageEligibilityResponse.insurance.item.category.coding.code",
        "min": 1,
        "fixedCode": "Heilmittel_Leistungsinformation",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.category.coding.userSelected",
        "path": "CoverageEligibilityResponse.insurance.item.category.coding.userSelected",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.productOrService",
        "path": "CoverageEligibilityResponse.insurance.item.productOrService",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier",
        "path": "CoverageEligibilityResponse.insurance.item.modifier",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "coding.system"
            }
          ],
          "rules": "closed"
        },
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:diagnosegruppe",
        "path": "CoverageEligibilityResponse.insurance.item.modifier",
        "sliceName": "diagnosegruppe",
        "short": "Indikationsschlüssel Diagnosegruppe",
        "min": 1,
        "max": "1",
        "mustSupport": true,
        "binding": {
          "strength": "required",
          "valueSet": "https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_HM_DIAGNOSEGRUPPE"
        }
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:diagnosegruppe.coding",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:diagnosegruppe.coding.system",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.system",
        "min": 1,
        "fixedUri": "https://fhir.kbv.de/CodeSystem/KBV_CS_SFHIR_HM_DIAGNOSEGRUPPE",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:diagnosegruppe.coding.code",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.code",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:diagnosegruppe.coding.userSelected",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.userSelected",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:diagnosegruppe.text",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.text",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code",
        "path": "CoverageEligibilityResponse.insurance.item.modifier",
        "sliceName": "icd_code",
        "short": "ICD Code",
        "definition": "In diesem Attribut können ICD-Codes zur Begründung der Heilmittelverordnung angegeben werden.",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Coding",
            "profile": [
              "http://fhir.de/StructureDefinition/CodingICD10GM|1.3.2"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding.extension",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding.extension:Mehrfachcodierungs-Kennzeichen",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.extension",
        "sliceName": "Mehrfachcodierungs-Kennzeichen",
        "min": 0,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding.extension:Seitenlokalisation",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.extension",
        "sliceName": "Seitenlokalisation",
        "min": 0,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding.extension:Diagnosesicherheit",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.extension",
        "sliceName": "Diagnosesicherheit",
        "min": 0,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding.system",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.system",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding.version",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.version",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.coding.code",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.coding.code",
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.modifier:icd_code.text",
        "path": "CoverageEligibilityResponse.insurance.item.modifier.text",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.provider",
        "path": "CoverageEligibilityResponse.insurance.item.provider",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.excluded",
        "path": "CoverageEligibilityResponse.insurance.item.excluded",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.name",
        "path": "CoverageEligibilityResponse.insurance.item.name",
        "short": "Bezeichnung des Heilmittels",
        "definition": "In diesem Feld muss die Bezeichnung des Heilmittels eingetragen werden.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.description",
        "path": "CoverageEligibilityResponse.insurance.item.description",
        "short": "Weitere Angaben",
        "definition": "In diesem Feld können weitere Angaben zur Leistungsgenehmigung dokumentiert werden.",
        "min": 1,
        "mustSupport": true
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.network",
        "path": "CoverageEligibilityResponse.insurance.item.network",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.unit",
        "path": "CoverageEligibilityResponse.insurance.item.unit",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.term",
        "path": "CoverageEligibilityResponse.insurance.item.term",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.benefit",
        "path": "CoverageEligibilityResponse.insurance.item.benefit",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.authorizationRequired",
        "path": "CoverageEligibilityResponse.insurance.item.authorizationRequired",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.authorizationSupporting",
        "path": "CoverageEligibilityResponse.insurance.item.authorizationSupporting",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.insurance.item.authorizationUrl",
        "path": "CoverageEligibilityResponse.insurance.item.authorizationUrl",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.preAuthRef",
        "path": "CoverageEligibilityResponse.preAuthRef",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.form",
        "path": "CoverageEligibilityResponse.form",
        "max": "0"
      },
      {
        "id": "CoverageEligibilityResponse.error",
        "path": "CoverageEligibilityResponse.error",
        "max": "0"
      }
    ]
  }
}