臺灣核心實作指引(TW Core IG)
0.3.2 - Trial Use

This page is part of the 臺灣核心實作指引(TW Core IG) (v0.3.2: Releases) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Resource Profile: TW Core Coverage

Official URL: https://twcore.mohw.gov.tw/ig/twcore/StructureDefinition/Coverage-twcore Version: 0.3.2
Active as of 2024-12-12 Computable Name: TWCoreCoverage

此臺灣核心-給付範圍(TW Core Coverage) Profile說明本IG如何進一步定義FHIR的Coverage Resource以呈現給付範圍資料。

Usage:

Formal Views of Profile Content

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

This structure is derived from Coverage

NameFlagsCard.TypeDescription & Constraintsdoco
.. Coverage C 0..* Coverage Insurance or medical plan or a payment agreement
tw-core-9: Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present
... Slices for identifier S 0..* Identifier Member ID and other identifiers
Slice: Unordered, Open by pattern:type
.... identifier:memberid SC 0..1 Identifier Member ID
..... type S 1..1 CodeableConcept Member Number identifier type
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: MB
..... assigner 0..1 Reference(TW Core Organization) Organization that issued id (may be just text)
... status S 1..1 code active | cancelled | draft | entered-in-error
... type S 0..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (extensible)
... subscriber 0..1 Reference(TW Core Patient | TW Core RelatedPerson) Subscriber to the policy
... subscriberId SC 0..1 string ID assigned to the subscriber
... beneficiary S 1..1 Reference(TW Core Patient) Plan beneficiary
... relationship S 1..1 CodeableConcept Beneficiary relationship to the subscriber
... period S 0..1 Period Coverage start and end dates
... payor S 1..1 Reference(TW Core Organization S | TW Core Patient | TW Core RelatedPerson) Issuer of the policy
... Slices for class S 0..* BackboneElement Additional coverage classifications
Slice: Unordered, Open by pattern:type
.... class:group S 0..1 BackboneElement Group
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: group
..... value S 1..1 string Group Number
..... name S 0..1 string Group Name
.... class:plan S 0..1 BackboneElement Plan
..... type 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Required Pattern: At least the following
...... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
....... system 1..1 uri Identity of the terminology system
Fixed Value: http://terminology.hl7.org/CodeSystem/coverage-class
....... code 1..1 code Symbol in syntax defined by the system
Fixed Value: plan
..... value S 1..1 string Plan Number
..... name S 0..1 string Plan Name

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Coverage.typeextensibleCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
from the FHIR Standard

Constraints

IdGradePath(s)DetailsRequirements
tw-core-9errorCoverageMember Id in Coverage.identifier or Coverage.subscriberId SHALL be present
: identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()

 

Other representations of profile: CSV, Excel, Schematron

Notes:

以下概述了此Profile所需的RESTful FHIR互動功能。有關TW Core IG支援的RESTful互動功能的完整清單,請參閱TW Core Server能力聲明

必須支援以下查詢參數:

  1. 必須(SHALL) 支援透過查詢參數 patient 查詢所有Coverage:
    (如何透過reference查詢)
    GET [base]/Coverage?patient={Type/}[id]

    例子:
    (1) GET [base]/Coverage?patient=Patient/pat-example