{
  "resourceType": "StructureDefinition",
  "id": "FPARCoverage",
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 2
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    }
  ],
  "url": "http://fhir.org/guides/hspc/StructureDefinition/fpar-coverage",
  "name": "fparCoverage",
  "status": "draft",
  "date": "2017-05-23",
  "publisher": "Healthcare Services Platform Consortium (HPSC) on behalf of FPAR",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://healthcaresoa.org"
        }
      ]
    }
  ],
  "description": "The Family Planning Annual Report Coverage Profile",
  "fhirVersion": "3.0.1",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/w5",
      "name": "W5 Mapping"
    },
    {
      "identity": "cdanetv4",
      "uri": "http://www.cda-adc.ca/en/services/cdanet/",
      "name": "Canadian Dental Association eclaims standard"
    },
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 v2 Mapping"
    },
    {
      "identity": "cpha3pharm",
      "uri": "http://www.pharmacists.ca/",
      "name": "Canadian Pharmacy Associaiton eclaims standard"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Coverage",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Coverage:fparCoverage",
        "path": "Coverage",
        "short": "Insurance or medical plan or a payment agreement",
        "definition": "Financial instrument which may be used to reimburse or pay for health care products and        services.",
        "min": 0,
        "max": "*",
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event"
          },
          {
            "identity": "rim",
            "map": "Coverage"
          },
          {
            "identity": "w5",
            "map": "financial.support"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.extension:PrimaryInsuranceClassification",
        "path": "Coverage.extension",
        "sliceName": "PrimaryInsuranceClassification",
        "short": "Extension",
        "definition": "An Extension",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coverage.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension",
            "profile": "http://fhir.org/guides/hspc/StructureDefinition/primaryInsuranceClassification"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "binding": {
          "strength": "required",
          "description": "Source of Payment Typology",
          "valueSetReference": {
            "reference": "https://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
          }
        },
        "mapping": [
          {
            "identity": "LOINC",
            "map": "76437-3"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.extension.extension:dataAbsendReason",
        "path": "Coverage.extension",
        "sliceName": "dataAbsentReason",
        "short": "Extension",
        "definition": "An Extension",
        "min": 0,
        "max": "1",
        "base": {
          "path": "Coverage.extension",
          "min": 0,
          "max": "*"
        },
        "type": [
          {
            "code": "Extension",
            "profile": "http://fhir.org/guides/hspc/StructureDefinition/dataAbsentReason"
          }
        ],
        "mustSupport": false,
        "isModifier": false,
        "binding": {
          "strength": "preferred",
          "description": "The reason why there is no data for the given element.",
          "valueSetReference": {
            "reference": "http://fhir.org/guides/hspc/CodeSystem/nullValueReason"
          }
        }
      },
      {
        "id": "Coverage:fparCoverage.identifier",
        "path": "Coverage.identifier",
        "short": "The primary coverage ID",
        "definition": "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 concatination        of the Coverage.SubscriberID and the Coverage.dependant.",
        "requirements": "This value may uniquely identify the coverage or it may be used in conjunction with the        additional identifiers below.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Identifier"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.identifier"
          },
          {
            "identity": "cdanetv4",
            "map": "C02"
          },
          {
            "identity": "v2",
            "map": "IN1-2"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.32, C.33, C.39"
          },
          {
            "identity": "w5",
            "map": "id"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.status",
        "path": "Coverage.status",
        "short": "active | cancelled | draft | entered-in-error",
        "definition": "The status of the resource instance.",
        "comment": "This element is labeled as a modifier because the status contains the code entered-in-error        that marks the coverage as not currently valid.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "code"
          }
        ],
        "isModifier": true,
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "CoverageStatus"
            }
          ],
          "strength": "required",
          "description": "A code specifying the state of the resource instance.",
          "valueSetReference": {
            "reference": "http://hl7.org/fhir/ValueSet/fm-status"
          }
        },
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.status"
          },
          {
            "identity": "w5",
            "map": "status"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.type",
        "path": "Coverage.type",
        "short": "Type of coverage such as medical or accident",
        "definition": "The type of coverage: social program, medical plan, accident coverage (workers compensation,        auto), group health or payment by an individual or organization.",
        "requirements": "The order of application of coverages is dependent on the types of coverage.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "isSummary": true,
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "FPAR Insurance Coverage Type"
            }
          ],
          "strength": "required",
          "description": "Low granularity classification of insurance coverage",
          "valueSetReference": {
            "reference": "https://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1166.29"
          }
        },
        "mapping": [
          {
            "identity": "v2",
            "map": "IN1-15"
          },
          {
            "identity": "w5",
            "map": "class"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.policyHolder",
        "path": "Coverage.policyHolder",
        "short": "Owner of the policy",
        "definition": "The party who 'owns' the insurance policy,  may be an individual, corporation or the subscriber's        employer.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "D01 through D09"
          },
          {
            "identity": "v2",
            "map": "IN1-16, 18,  19-name of insured, address, date of birth"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.35"
          },
          {
            "identity": "w5",
            "map": "who.focus"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.subscriber",
        "path": "Coverage.subscriber",
        "short": "Subscriber to the policy",
        "definition": "The party who has signed-up for or 'owns' the contractual relationship to the policy or        to whom the benefit of the policy for services rendered to them or their family is due.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "D01 through D09"
          },
          {
            "identity": "v2",
            "map": "IN1-16, 18,  19-name of insured, address, date of birth"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.35"
          },
          {
            "identity": "w5",
            "map": "who.focus"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.subscriberId",
        "path": "Coverage.subscriberId",
        "short": "ID assigned to the Subscriber",
        "definition": "The insurer assigned ID for the Subscriber.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "D01 through D09"
          },
          {
            "identity": "v2",
            "map": "IN1-16, 18,  19-name of insured, address, date of birth"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.35"
          },
          {
            "identity": "w5",
            "map": "who.focus"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.beneficiary",
        "path": "Coverage.beneficiary",
        "short": "Plan Beneficiary",
        "definition": "The party who benefits from the insurance coverage., the patient when services are provided.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.subject"
          },
          {
            "identity": "cdanetv4",
            "map": "D01 through D09"
          },
          {
            "identity": "v2",
            "map": "IN1-16, 18,  19-name of insured, address, date of birth"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.35"
          },
          {
            "identity": "w5",
            "map": "who.focus"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.relationship",
        "path": "Coverage.relationship",
        "short": "Beneficiary relationship to the Subscriber",
        "definition": "The relationship of beneficiary (patient) to the subscriber.",
        "requirements": "To determine relationship between the patient and the subscriber.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
              "valueString": "Relationship"
            }
          ],
          "strength": "example",
          "description": "The relationship between the Policyholder and the Beneficiary (insured/covered party/patient).",
          "valueSetReference": {
            "reference": "http://hl7.org/fhir/ValueSet/policyholder-relationship"
          }
        },
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C03"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.period",
        "path": "Coverage.period",
        "short": "Coverage start and end dates",
        "definition": "Time period during which the coverage is in force. A missing start date indicates the        start date isn't known, a missing end date means the coverage is continuing to be in force.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Period"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "workflow",
            "map": "Event.occurrence"
          },
          {
            "identity": "v2",
            "map": "IN1-12 / IN1-13"
          },
          {
            "identity": "w5",
            "map": "when.done"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.payor",
        "path": "Coverage.payor",
        "short": "Identifier for the plan or agreement issuer",
        "definition": "The program or plan underwriter or payor including both insurance and non-insurance agreements,        such as patient-pay agreements. May provide multiple identifiers such as insurance company        identifier or business identifier (BIN number).",
        "requirements": "Need to identify the issuer to target for processing and for coordination of benefit processing.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
          },
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "A05"
          },
          {
            "identity": "v2",
            "map": "IN1-3"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.30"
          },
          {
            "identity": "w5",
            "map": "who.author"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping",
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name",
            "valueString": "Group"
          }
        ],
        "path": "Coverage.grouping",
        "short": "Additional coverage classifications",
        "definition": "A suite of underwrite specific classifiers, for example may be used to identify a class        of coverage or employer group, Policy, Plan.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "BackboneElement"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.group",
        "path": "Coverage.grouping.group",
        "short": "An identifier for the group",
        "definition": "Identifies a style or collective of coverage issued by the underwriter, for example may        be used to identify an employer group. May also be referred to as a Policy or Group ID.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C11 (Division,Section)"
          },
          {
            "identity": "v2",
            "map": "IN1-8"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.31"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.groupDisplay",
        "path": "Coverage.grouping.groupDisplay",
        "short": "Display text for an identifier for the group",
        "definition": "A short description for the group.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C11 (Division,Section)"
          },
          {
            "identity": "v2",
            "map": "IN1-8"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.31"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.subGroup",
        "path": "Coverage.grouping.subGroup",
        "short": "An identifier for the subsection of the group",
        "definition": "Identifies a style or collective of coverage issued by the underwriter, for example may        be used to identify a subset of an employer group.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "IN1-8"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.subGroupDisplay",
        "path": "Coverage.grouping.subGroupDisplay",
        "short": "Display text for the subsection of the group",
        "definition": "A short description for the subgroup.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "IN1-8"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.plan",
        "path": "Coverage.grouping.plan",
        "short": "An identifier for the plan",
        "definition": "Identifies a style or collective of coverage issued by the underwriter, for example may        be used to identify a collection of benefits provided to employees. May be referred to        as a Section or Division ID.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C01"
          },
          {
            "identity": "v2",
            "map": "IN1-35"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.planDisplay",
        "path": "Coverage.grouping.planDisplay",
        "short": "Display text for the plan",
        "definition": "A short description for the plan.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C01"
          },
          {
            "identity": "v2",
            "map": "IN1-35"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.subPlan",
        "path": "Coverage.grouping.subPlan",
        "short": "An identifier for the subsection of the plan",
        "definition": "Identifies a sub-style or sub-collective of coverage issued by the underwriter, for example        may be used to identify a subset of a collection of benefits provided to employees.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "IN1-10"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.subPlanDisplay",
        "path": "Coverage.grouping.subPlanDisplay",
        "short": "Display text for the subsection of the plan",
        "definition": "A short description for the subplan.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "IN1-10"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.class",
        "path": "Coverage.grouping.class",
        "short": "An identifier for the class",
        "definition": "Identifies a style or collective of coverage issues by the underwriter, for example may        be used to identify a class of coverage such as a level of deductables or co-payment.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C01"
          },
          {
            "identity": "v2",
            "map": "IN1-35"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.classDisplay",
        "path": "Coverage.grouping.classDisplay",
        "short": "Display text for the class",
        "definition": "A short description for the class.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C01"
          },
          {
            "identity": "v2",
            "map": "IN1-35"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.subClass",
        "path": "Coverage.grouping.subClass",
        "short": "An identifier for the subsection of the class",
        "definition": "Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example        may be used to identify a subclass of coverage such as a sub-level of deductables or co-payment.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C01"
          },
          {
            "identity": "v2",
            "map": "IN1-35"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.grouping.subClassDisplay",
        "path": "Coverage.grouping.subClassDisplay",
        "short": "Display text for the subsection of the subclass",
        "definition": "A short description for the subclass.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C01"
          },
          {
            "identity": "v2",
            "map": "IN1-35"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.dependent",
        "path": "Coverage.dependent",
        "short": "Dependent number",
        "definition": "A unique identifier for a dependent under the coverage.",
        "requirements": "For some coverage a single identifier is issued to the Subscriber and a dependent number        issued to each beneficiary.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "C17"
          },
          {
            "identity": "v2",
            "map": "- No exact HL7 v2 equivalent concept seems to exist;"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.sequence",
        "path": "Coverage.sequence",
        "short": "The plan instance or sequence counter",
        "definition": "An optional counter for a particular instance of the identified coverage which increments        upon each renewal.",
        "requirements": "Some coverage, for example social plans, may be offered in short time increments, for        example for a week or a month at a time, so while the rest of the plan details and identifiers        may remain constant over time, the instance is incremented with each renewal and provided        to the covered party on their 'card'.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "D11"
          },
          {
            "identity": "v2",
            "map": "No HL7 v2 equivalent concept seems to exist"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.order",
        "path": "Coverage.order",
        "short": "Relative order of the coverage",
        "definition": "The order of applicability of this coverage relative to other coverages which are currently        inforce. Note, there may be gaps in the numbering and this does not imply primary, secondard        etc. as the specific positioning of coverages depends upon the episode of care.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "positiveInt"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "v2",
            "map": "- No exact HL7 v2 equivalent concept seems to exist;"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.network",
        "path": "Coverage.network",
        "short": "Insurer network",
        "definition": "The insurer-specific identifier for the insurer-defined network of providers to which        the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise        'out of network' terms and conditions apply.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "string"
          }
        ],
        "isSummary": true,
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "D10"
          }
        ]
      },
      {
        "id": "Coverage:fparCoverage.contract",
        "path": "Coverage.contract",
        "short": "Contract details",
        "definition": "The policy(s) which constitute this insurance coverage.",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Reference",
            "targetProfile": "http://hl7.org/fhir/StructureDefinition/Contract"
          }
        ],
        "mapping": [
          {
            "identity": "cdanetv4",
            "map": "D01 through D09"
          },
          {
            "identity": "v2",
            "map": "IN1-16, 18,  19"
          },
          {
            "identity": "cpha3pharm",
            "map": "C.35"
          }
        ]
      }
    ]
  }
}