FHIR Implementation Guide for HCX
0.7.0 - CI Build
FHIR Implementation Guide for HCX
0.7.0 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.7.0). See the Directory of published versions
<ValueSet xmlns="http://hl7.org/fhir">
<id value="claim-supporting-info-codes"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>This value set contains 229 concepts</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>System</b></td><td><b>Display</b></td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-1"> </a> POI-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Aadhar Identity Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-2"> </a> POI-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Passport</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-3"> </a> POI-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Driving License</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-4"> </a> POI-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Election Commision's Voter ID card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-5"> </a> POI-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Income Tax PAN Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-6"> </a> POI-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Photo Credit Card/ Debit card (with Photo)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-7"> </a> POI-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ECHS / CGHS Card having photo</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-8"> </a> POI-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Domicile Certificate / Caste Certificate with photograph</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-9"> </a> POI-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Current passbook of Post Office / Govt. /PSU Bank/private banks</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-10"> </a> POI-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Student ID card of the Govt. recognized educational institutions with photograph on it.</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-11"> </a> POI-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Ration Card with photograph & address. (Issued from Maharashtra state not valid )</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-12"> </a> POI-12</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Smart Card issued by CSD, Defence / Paramilitary Forces</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-13"> </a> POI-13</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Arms License</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-14"> </a> POI-14</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Senior Citizen Card having photo issued by the Govt.</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-15"> </a> POI-15</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Pensioners Card having photo issued by the Govt.</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-16"> </a> POI-16</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ID Card issued to Tibetan (Refugees) Citizens by State Govt. / Central Govt. of India having photo</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-17"> </a> POI-17</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Defence Personnel - Armed Forces ;Certificate from Competent Unit Authority</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-18"> </a> POI-18</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Address having Photo, issued by MP/ MLA / Group A Gazetted Officer on letter head with seal</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-19"> </a> POI-19</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of address with photo from Govt. recognized educational institution (for students only)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-20"> </a> POI-20</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Address having Photo, issued by Head of Village / Gram Panchayat or its equivalent Authority. (for Rural Areas)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-21"> </a> POI-21</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Address Card with Photo issued by Dept. of Posts</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-23"> </a> POI-23</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Freedom fighter card with photo</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POI-24"> </a> POI-24</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Kissan Passbook with photo</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-1"> </a> POA-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Aadhaar Identity Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-2"> </a> POA-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Attachment</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-3"> </a> POA-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Passport</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-4"> </a> POA-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Driving License (Issued from Maharashtra state not valid )</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-5"> </a> POA-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Election Commission’s Voter ID Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-6"> </a> POA-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Vehicle Registration Certificate / Smart card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-7"> </a> POA-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Water Bill with address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-8"> </a> POA-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Electricity Bill of Govt./private company (not older than 3 months)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-9"> </a> POA-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Telephone Bill of a fixed line. (Any Service Provider)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-10"> </a> POA-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Registered Sale/Lease (Rent) Agreement</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-11"> </a> POA-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Credit card statement with address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-12"> </a> POA-12</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Ration Card with photograph. (Issued from Maharashtra state not valid )</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-13"> </a> POA-13</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of address with photo from Govt. recognized educational institution (for students only)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-14"> </a> POA-14</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Current passbook of Post Office / Govt./PSU/private banks with complete address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-15"> </a> POA-15</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>IT Assessment Order</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-16"> </a> POA-16</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ECHS / CGHS Card having photo & address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-17"> </a> POA-17</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Domicile Certificate / Caste Certificate with photograph & address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-18"> </a> POA-18</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Arms License</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-19"> </a> POA-19</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Senior Citizen Card having photo & address issued by the Govt.</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-20"> </a> POA-20</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Pensioners Card having photo & address issued by the Govt.</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-21"> </a> POA-21</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ID Card issued to Tibetan (Refugees) Citizens by State Govt. / Central Govt. of India having photo & address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-22"> </a> POA-22</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Defence Personnel – Armed Forces ;Certificate from Competent Unit Authority</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-23"> </a> POA-23</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Address having Photo, issued by MP/ MLA / Group A Gazetted Officer on letter head with seal</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-24"> </a> POA-24</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Address having Photo, issued by Head of Village / Gram Panchayat or its equivalent Authority. (for Rural Areas)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-25"> </a> POA-25</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Address Card with Photo issued by Dept. of Posts</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-26"> </a> POA-26</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Freedom fighter card with photo & address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-27"> </a> POA-27</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Kissan Passbook with photo & address</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POA-28"> </a> POA-28</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Surrender ID Card (BLT etc.) issued by Govt. of India & signed by IGP of the state</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-1"> </a> POR-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PDS Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-2"> </a> POR-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>MNREGA Job Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-3"> </a> POR-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>CGHS/ State Government/ ECHS/ ESIC Medical card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-4"> </a> POR-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Pension Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-5"> </a> POR-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Army Canteen Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-6"> </a> POR-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Passport</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-7"> </a> POR-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Birth Certificate issued by Registrar of Birth, Municipal Corporation and other notified local government bodies like Taluk, Tehsil etc.</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-8"> </a> POR-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Any other Central/ State government issued family entitlement document</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-9"> </a> POR-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Marriage Certificate issued by the government</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-10"> </a> POR-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Address card having name and photo issued by Department of Posts</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-11"> </a> POR-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Bhamashah Card/Jan-Aadhaar card issued by Govt. of Rajasthan</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-12"> </a> POR-12</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Discharge card/ slip issued by Government hospitals for birth of a child</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-13"> </a> POR-13</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Identity having photo issued by MP or MLA or MLC or Municipal Councillor or Gazetted Officer on UIDAI standard certificate format</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-POR-14"> </a> POR-14</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Identity having photo and relationship with HoF issued by Village Panchayat Head or Mukhiya or its equivalent authority (for rural areas)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-1"> </a> DOB-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Birth Certificate issued by Registrar of Birth, Municipal Corporation and other notified local government bodies like Taluk, Tehsil etc.</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-2"> </a> DOB-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>SSLC Book/ Certificate</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-3"> </a> DOB-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Passport</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-4"> </a> DOB-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Date of Birth issued by Group A Gazetted Officer on UIDAI standard certificate format</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-5"> </a> DOB-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>A certificate (on UIDAI standard certificate format for enrolment/ update) or ID Card having photo and Date of Birth (DOB) duly signed and issued by a Government authority</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-6"> </a> DOB-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Photo ID card having Date of Birth, issued by Recognized Educational Institution</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-7"> </a> DOB-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PAN Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-8"> </a> DOB-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Marksheet issued by any Government Board or University</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-9"> </a> DOB-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Government Photo ID Card/ Photo Identity Card issued by PSU containing DOB</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-10"> </a> DOB-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Central/ State Pension Payment Order</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-11"> </a> DOB-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Central Government Health Service Scheme Photo Card or Ex-Servicemen Contributory Health Scheme Photo card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-12"> </a> DOB-12</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>School Leaving Certificate (SLC)/ School Transfer Certificate (TC), containing Name and Date of Birth</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-13"> </a> DOB-13</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Extract of School Records issued by Head of School containing Name, Date of Birth and Photograph</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-14"> </a> DOB-14</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of Identity containing Name, DOB and Photo issued by Recognized Educational Institution signed by Head of Institute on UIDAI standard certificate format</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DOB-15"> </a> DOB-15</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Certificate of identity containing Name, DOB and Photograph issued by Employees’ Provident Fund Organisation (EPFO) on UIDAI standard certificate format</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-PHT-1"> </a> PHT-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Photograph of self</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-PHT-2"> </a> PHT-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Photograph of family</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-PHT-3"> </a> PHT-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Photograph of dead person</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-PHT-4"> </a> PHT-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Photograph (any other required for claims adjudication)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-BVC-1"> </a> BVC-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PMJAY Beneficiary Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-BVC-2"> </a> BVC-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Insurance Card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-BVC-3"> </a> BVC-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Employment ID card (for corporate cases)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-BVC-4"> </a> BVC-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ESHS/ESI card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-BVC-5"> </a> BVC-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Bhamashah Card or any other Insurance scheme card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DEF-1"> </a> DEF-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Self signed declaration form</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DEF-2"> </a> DEF-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Hospital stamped and signed hospital declaration form</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DEF-3"> </a> DEF-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Any other consent form or miscellaneous declaration form</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-SIG-1"> </a> SIG-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>self signature (wet signature) scanned copy</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-SIG-2"> </a> SIG-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>hospital signature and stamp (scanned copy)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-FCF-1"> </a> FCF-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>duly signed filled Preauthorization form (scan)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-FCF-2"> </a> FCF-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>duly signed filled Claim form (scan)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CER"> </a> CER</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Medical Certificate</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-MB-1"> </a> MB-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Final Bill</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-MB-2"> </a> MB-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Interim Bill</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-MB-3"> </a> MB-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Estimate Bill</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIA-1"> </a> DIA-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Lab Investigation Report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIA-2"> </a> DIA-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Radiology Report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIA-3"> </a> DIA-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Imaging Report with studies</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIA-4"> </a> DIA-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Genetic Assessment Report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-HDS-1"> </a> HDS-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Discharge Summary Report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-HDS-2"> </a> HDS-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Death Summary Report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-HDS-3"> </a> HDS-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Discharge Summary with LAMA/DAMA</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REF-1"> </a> REF-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>CGHS Refferal Letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REF-2"> </a> REF-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ECHS/ESI Doctor Referral Letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REF-3"> </a> REF-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Doctor Referral letter (to specialist)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REF-4"> </a> REF-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Upward Referral Letter (referral from HWC, SC, PHC,CHC to District Hospital)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REF-5"> </a> REF-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Downward Referral Letter (referral from higher facility to the original referee facility)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REF-6"> </a> REF-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Inter Hospital Referral Letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REF-7"> </a> REF-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Doctor Referral letter (to hospital)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DEL-1"> </a> DEL-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Doctor signed treatment extension letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DEL-2"> </a> DEL-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Doctor signed discharge extension letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DEL-3"> </a> DEL-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>post discharge readmission request letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-1"> </a> CD-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Doctor Prescription</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-2"> </a> CD-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Consultation Summary Note</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-3"> </a> CD-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Daily progress note</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-4"> </a> CD-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Nursing notes</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-5"> </a> CD-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>OT Surgery Notes</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-6"> </a> CD-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Flowsheet</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-7"> </a> CD-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ICU monitoring reports with notes</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-8"> </a> CD-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Medication Diapensation Notes</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-9"> </a> CD-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>CarePlan</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-10"> </a> CD-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Emergency Treatment Notes</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-11"> </a> CD-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Bedside monitoring report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CD-12"> </a> CD-12</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Point of care testing report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EID-1"> </a> EID-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Employment ID card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EID-2"> </a> EID-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>CGHS card or Pension document</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EID-3"> </a> EID-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ECHS service card</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-FIR-1"> </a> FIR-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>FIR report</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CIL-1"> </a> CIL-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Preauthorization approval letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CIL-2"> </a> CIL-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Claim approval letter</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CIL--3"> </a> CIL- 3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Treatment Authorization latter from employer(for public and private sector employees,CGHS, ECHS employees)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-1"> </a> DIS-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>LAMA</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-2"> </a> DIS-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>DAMA</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-3"> </a> DIS-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Normal Discharge</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-4"> </a> DIS-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Death</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-5"> </a> DIS-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>DischargeToHome (Discharge disposition status)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-6"> </a> DIS-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>DischargetoMortuary(death disposition)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-7"> </a> DIS-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>DischargeToUnknownLocation</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-8"> </a> DIS-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>DischargeToDifferentState</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-DIS-9"> </a> DIS-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>DischargeToDifferentCountry</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-ONS-1"> </a> ONS-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Admission date -Discharge date</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-ONS-2"> </a> ONS-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Discharge start-discharge end time</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-ONS-3"> </a> ONS-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PatientNormalRoom (start datetime- enddatetime)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-ONS-4"> </a> ONS-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PatientEmergencyRoom(start datetime-enddatetime)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-ONS-5"> </a> ONS-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PatientSurgeryPerformed(startdatetime-enddatetime)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-ONS-6"> </a> ONS-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PatientICUStay (startdatetime-enddatetime)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REL-1"> </a> REL-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ProcedurePerformedDetail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REL-2"> </a> REL-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ProcedurePerformedDateTime</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REL-3"> </a> REL-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ServiceRenderedDetail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REL-4"> </a> REL-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ServiceRenderedDateTime</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REL-5"> </a> REL-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>InvestigationPerformedDetail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-REL-6"> </a> REL-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>InvestigationPerformedDetailDateTime</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EXC-1"> </a> EXC-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>InsurancePolicyExclusions</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EXC-2"> </a> EXC-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>CostlyProcedureNotCoveredInPolicy</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EXC-3"> </a> EXC-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ExpensiveMedicinesNotCoveredinPackage</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EXC-4"> </a> EXC-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ConsummablesAndDisposiblesNotcoveredinPolicy</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-EMP-1"> </a> EMP-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>EmploymentDetail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-1"> </a> COI-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Cause of Injury or Accident</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-2"> </a> COI-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Patient Condition at time of admission after injury</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-3"> </a> COI-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Vehicle Acident detail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-4"> </a> COI-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Fire Burns detail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-5"> </a> COI-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Snake Bite detail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-6"> </a> COI-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Electric Shock detail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI--7"> </a> COI -7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Consumption of Poisonous substance detail(FIR Registered or not)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-8"> </a> COI-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Attack on human body detail (FIR Registered or not)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-9"> </a> COI-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ImmediateTreatmentProvidedToPatientAfterAccident</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-10"> </a> COI-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>AnyPreviousClaimsDueToAccident (previous claim details)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-11"> </a> COI-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Date of Accident or Injury</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-COI-12"> </a> COI-12</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Date-Time of Hospitalization Due to Accident</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-VRE-1"> </a> VRE-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>EncounterDateTime</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-VRE-2"> </a> VRE-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>EncounterType</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-VRE-3"> </a> VRE-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>ReasonCodes (encounter reason)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-VRE-4"> </a> VRE-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>EncounterOutcome</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CRD-1"> </a> CRD-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Claim received date time</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CRD-2"> </a> CRD-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>document details (submitted with claims)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-CRD-3"> </a> CRD-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>courier number of claim reciept</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-1"> </a> IND-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>MLC Case (Boolean Y/N)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-2"> </a> IND-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>MultiPayorClaim (Boolean Y/N)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-3"> </a> IND-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Primary and Secondary Payor Details (in case of Multi Payor claims)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-4"> </a> IND-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PrimaryorSecondaryClaim</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-5"> </a> IND-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Details of claim settled by primary payor (in case of secondary claims - attachment)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-6"> </a> IND-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PMJAYInsurancePortabilityCase (Y/N) (treatment received in a different state)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-7"> </a> IND-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>PrimarySHADetails (SHA/TPA detail of state where PMJAY benefeciary belongs to)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-8"> </a> IND-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>SecondarySHADetails (SHA/TPA detail of state where benefeciary received treatment)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-9"> </a> IND-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>EmploymentImpacted (Y/N) for long disabilities)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-10"> </a> IND-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Employment impacted period (start date - end date)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-IND-11"> </a> IND-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>HospitalizedIndicator (if patient was hospitalized or not - Y/N)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-MAT-1"> </a> MAT-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Materials Forwarded</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-NMI-1"> </a> NMI-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Claim query detail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-TRD-1"> </a> TRD-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Treatment detail</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-1"> </a> INF-1</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>additional info related to claim ( conveying additional situation and condition information.)</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-2"> </a> INF-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Family Physician Name</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-3"> </a> INF-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Family Physician Contact</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-4"> </a> INF-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Family Physician Number</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-5"> </a> INF-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Insurance Number</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-6"> </a> INF-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Insurance Company</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-7"> </a> INF-7</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Employee ID</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-8"> </a> INF-8</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Employer Name</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-9"> </a> INF-9</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Hospital Name</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-10"> </a> INF-10</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Rohini ID</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-11"> </a> INF-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Email</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-11"> </a> INF-11</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Name of Insurance Company</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-12"> </a> INF-12</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Name of TPA</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-13"> </a> INF-13</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Proposer Name</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-14"> </a> INF-14</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Patient's Member ID</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-15"> </a> INF-15</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Relation with Proposer</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-16"> </a> INF-16</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Expected Date of Admission</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-17"> </a> INF-17</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Policy Number</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-18"> </a> INF-18</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Expected Date of Discharge</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-19"> </a> INF-19</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Room category</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-20"> </a> INF-20</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Eligible Room Category as per T&C of Policy Contract</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-21"> </a> INF-21</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Provisional Diagnosis</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-22"> </a> INF-22</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Proposed line of treatment</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-23"> </a> INF-23</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Estimated Length of stay</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-TRD-2"> </a> TRD-2</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Medical Management</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-TRD-3"> </a> TRD-3</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Surgical Management</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-TRD-4"> </a> TRD-4</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Intensive Care</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-TRD-5"> </a> TRD-5</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Investigation</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-TRD-6"> </a> TRD-6</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Non allopathic treatment</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-24"> </a> INF-24</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Name of treating Doctor</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-25"> </a> INF-25</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Qualitifcation</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-INF-26"> </a> INF-26</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Registation Number</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-PoPr.locationPhoto"> </a> PoPr.locationPhoto</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Photo of the location with subject</td></tr><tr><td style="white-space:nowrap"><a name="http---hcxprotocol.io-codes-claim-supporting-info-codes-PoPr.deviceLocation"> </a> PoPr.deviceLocation</td><td>http://hcxprotocol.io/codes/claim-supporting-info-codes</td><td>Real time geolocation from certified devices</td></tr></table></div>
</text>
<url
value="https://ig.hcxprotocol.io/v0.7/ValueSet-claim-supporting-info-codes.html"/>
<version value="0.7.0"/>
<name value="ClaimSupportingInfoCodes"/>
<status value="active"/>
<date value="2022-08-01"/>
<publisher value="HCX Open Community"/>
<contact>
<name value="HCX Open Community"/>
<telecom>
<system value="url"/>
<value value="http://hcxprotocol.io/"/>
</telecom>
</contact>
<description
value="This is the value set for the codes of different supporting information that can be shared along with the submission of a claim"/>
<expansion>
<timestamp value="2022-08-01T08:15:30+05:30"/>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-1"/>
<display value="Aadhar Identity Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-2"/>
<display value="Passport"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-3"/>
<display value="Driving License"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-4"/>
<display value="Election Commision's Voter ID card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-5"/>
<display value="Income Tax PAN Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-6"/>
<display value="Photo Credit Card/ Debit card (with Photo)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-7"/>
<display value="ECHS / CGHS Card having photo"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-8"/>
<display
value="Domicile Certificate / Caste Certificate with photograph"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-9"/>
<display
value="Current passbook of Post Office / Govt. /PSU Bank/private banks"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-10"/>
<display
value="Student ID card of the Govt. recognized educational institutions with photograph on it."/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-11"/>
<display
value="Ration Card with photograph & address. (Issued from Maharashtra state not valid )"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-12"/>
<display
value="Smart Card issued by CSD, Defence / Paramilitary Forces"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-13"/>
<display value="Arms License"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-14"/>
<display value="Senior Citizen Card having photo issued by the Govt."/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-15"/>
<display value="Pensioners Card having photo issued by the Govt."/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-16"/>
<display
value="ID Card issued to Tibetan (Refugees) Citizens by State Govt. / Central Govt. of India having photo"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-17"/>
<display
value="Defence Personnel - Armed Forces ;Certificate from Competent Unit Authority"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-18"/>
<display
value="Certificate of Address having Photo, issued by MP/ MLA / Group A Gazetted Officer on letter head with seal"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-19"/>
<display
value="Certificate of address with photo from Govt. recognized educational institution (for students only)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-20"/>
<display
value="Certificate of Address having Photo, issued by Head of Village / Gram Panchayat or its equivalent Authority. (for Rural Areas)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-21"/>
<display value="Address Card with Photo issued by Dept. of Posts"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-23"/>
<display value="Freedom fighter card with photo"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POI-24"/>
<display value="Kissan Passbook with photo"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-1"/>
<display value="Aadhaar Identity Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-2"/>
<display value="Attachment"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-3"/>
<display value="Passport"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-4"/>
<display
value="Driving License (Issued from Maharashtra state not valid )"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-5"/>
<display value="Election Commission’s Voter ID Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-6"/>
<display value="Vehicle Registration Certificate / Smart card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-7"/>
<display value="Water Bill with address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-8"/>
<display
value="Electricity Bill of Govt./private company (not older than 3 months)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-9"/>
<display
value="Telephone Bill of a fixed line. (Any Service Provider)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-10"/>
<display value="Registered Sale/Lease (Rent) Agreement"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-11"/>
<display value="Credit card statement with address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-12"/>
<display
value="Ration Card with photograph. (Issued from Maharashtra state not valid )"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-13"/>
<display
value="Certificate of address with photo from Govt. recognized educational institution (for students only)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-14"/>
<display
value="Current passbook of Post Office / Govt./PSU/private banks with complete address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-15"/>
<display value="IT Assessment Order"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-16"/>
<display value="ECHS / CGHS Card having photo & address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-17"/>
<display
value="Domicile Certificate / Caste Certificate with photograph & address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-18"/>
<display value="Arms License"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-19"/>
<display
value="Senior Citizen Card having photo & address issued by the Govt."/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-20"/>
<display
value="Pensioners Card having photo & address issued by the Govt."/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-21"/>
<display
value="ID Card issued to Tibetan (Refugees) Citizens by State Govt. / Central Govt. of India having photo & address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-22"/>
<display
value="Defence Personnel – Armed Forces ;Certificate from Competent Unit Authority"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-23"/>
<display
value="Certificate of Address having Photo, issued by MP/ MLA / Group A Gazetted Officer on letter head with seal"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-24"/>
<display
value="Certificate of Address having Photo, issued by Head of Village / Gram Panchayat or its equivalent Authority. (for Rural Areas)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-25"/>
<display value="Address Card with Photo issued by Dept. of Posts"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-26"/>
<display value="Freedom fighter card with photo & address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-27"/>
<display value="Kissan Passbook with photo & address"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POA-28"/>
<display
value="Surrender ID Card (BLT etc.) issued by Govt. of India & signed by IGP of the state"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-1"/>
<display value="PDS Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-2"/>
<display value="MNREGA Job Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-3"/>
<display value="CGHS/ State Government/ ECHS/ ESIC Medical card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-4"/>
<display value="Pension Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-5"/>
<display value="Army Canteen Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-6"/>
<display value="Passport"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-7"/>
<display
value="Birth Certificate issued by Registrar of Birth, Municipal Corporation and other notified local government bodies like Taluk, Tehsil etc."/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-8"/>
<display
value="Any other Central/ State government issued family entitlement document"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-9"/>
<display value="Marriage Certificate issued by the government"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-10"/>
<display
value="Address card having name and photo issued by Department of Posts"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-11"/>
<display
value="Bhamashah Card/Jan-Aadhaar card issued by Govt. of Rajasthan"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-12"/>
<display
value="Discharge card/ slip issued by Government hospitals for birth of a child"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-13"/>
<display
value="Certificate of Identity having photo issued by MP or MLA or MLC or Municipal Councillor or Gazetted Officer on UIDAI standard certificate format"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="POR-14"/>
<display
value="Certificate of Identity having photo and relationship with HoF issued by Village Panchayat Head or Mukhiya or its equivalent authority (for rural areas)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-1"/>
<display
value="Birth Certificate issued by Registrar of Birth, Municipal Corporation and other notified local government bodies like Taluk, Tehsil etc."/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-2"/>
<display value="SSLC Book/ Certificate"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-3"/>
<display value="Passport"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-4"/>
<display
value="Certificate of Date of Birth issued by Group A Gazetted Officer on UIDAI standard certificate format"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-5"/>
<display
value="A certificate (on UIDAI standard certificate format for enrolment/ update) or ID Card having photo and Date of Birth (DOB) duly signed and issued by a Government authority"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-6"/>
<display
value="Photo ID card having Date of Birth, issued by Recognized Educational Institution"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-7"/>
<display value="PAN Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-8"/>
<display
value="Marksheet issued by any Government Board or University"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-9"/>
<display
value="Government Photo ID Card/ Photo Identity Card issued by PSU containing DOB"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-10"/>
<display value="Central/ State Pension Payment Order"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-11"/>
<display
value="Central Government Health Service Scheme Photo Card or Ex-Servicemen Contributory Health Scheme Photo card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-12"/>
<display
value="School Leaving Certificate (SLC)/ School Transfer Certificate (TC), containing Name and Date of Birth"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-13"/>
<display
value="Extract of School Records issued by Head of School containing Name, Date of Birth and Photograph"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-14"/>
<display
value="Certificate of Identity containing Name, DOB and Photo issued by Recognized Educational Institution signed by Head of Institute on UIDAI standard certificate format"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DOB-15"/>
<display
value="Certificate of identity containing Name, DOB and Photograph issued by Employees’ Provident Fund Organisation (EPFO) on UIDAI standard certificate format"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="PHT-1"/>
<display value="Photograph of self"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="PHT-2"/>
<display value="Photograph of family"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="PHT-3"/>
<display value="Photograph of dead person"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="PHT-4"/>
<display
value="Photograph (any other required for claims adjudication)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="BVC-1"/>
<display value="PMJAY Beneficiary Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="BVC-2"/>
<display value="Insurance Card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="BVC-3"/>
<display value="Employment ID card (for corporate cases)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="BVC-4"/>
<display value="ESHS/ESI card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="BVC-5"/>
<display value="Bhamashah Card or any other Insurance scheme card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DEF-1"/>
<display value="Self signed declaration form"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DEF-2"/>
<display value="Hospital stamped and signed hospital declaration form"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DEF-3"/>
<display
value="Any other consent form or miscellaneous declaration form"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="SIG-1"/>
<display value="self signature (wet signature) scanned copy"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="SIG-2"/>
<display value="hospital signature and stamp (scanned copy)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="FCF-1"/>
<display value="duly signed filled Preauthorization form (scan)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="FCF-2"/>
<display value="duly signed filled Claim form (scan)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CER"/>
<display value="Medical Certificate"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="MB-1"/>
<display value="Final Bill"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="MB-2"/>
<display value="Interim Bill"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="MB-3"/>
<display value="Estimate Bill"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIA-1"/>
<display value="Lab Investigation Report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIA-2"/>
<display value="Radiology Report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIA-3"/>
<display value="Imaging Report with studies"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIA-4"/>
<display value="Genetic Assessment Report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="HDS-1"/>
<display value="Discharge Summary Report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="HDS-2"/>
<display value="Death Summary Report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="HDS-3"/>
<display value="Discharge Summary with LAMA/DAMA"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REF-1"/>
<display value="CGHS Refferal Letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REF-2"/>
<display value="ECHS/ESI Doctor Referral Letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REF-3"/>
<display value="Doctor Referral letter (to specialist)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REF-4"/>
<display
value="Upward Referral Letter (referral from HWC, SC, PHC,CHC to District Hospital)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REF-5"/>
<display
value="Downward Referral Letter (referral from higher facility to the original referee facility)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REF-6"/>
<display value="Inter Hospital Referral Letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REF-7"/>
<display value="Doctor Referral letter (to hospital)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DEL-1"/>
<display value="Doctor signed treatment extension letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DEL-2"/>
<display value="Doctor signed discharge extension letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DEL-3"/>
<display value="post discharge readmission request letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-1"/>
<display value="Doctor Prescription"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-2"/>
<display value="Consultation Summary Note"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-3"/>
<display value="Daily progress note"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-4"/>
<display value="Nursing notes"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-5"/>
<display value="OT Surgery Notes"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-6"/>
<display value="Flowsheet"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-7"/>
<display value="ICU monitoring reports with notes"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-8"/>
<display value="Medication Diapensation Notes"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-9"/>
<display value="CarePlan"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-10"/>
<display value="Emergency Treatment Notes"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-11"/>
<display value="Bedside monitoring report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CD-12"/>
<display value="Point of care testing report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EID-1"/>
<display value="Employment ID card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EID-2"/>
<display value="CGHS card or Pension document"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EID-3"/>
<display value="ECHS service card"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="FIR-1"/>
<display value="FIR report"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CIL-1"/>
<display value="Preauthorization approval letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CIL-2"/>
<display value="Claim approval letter"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CIL- 3"/>
<display
value="Treatment Authorization latter from employer(for public and private sector employees,CGHS, ECHS employees)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-1"/>
<display value="LAMA"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-2"/>
<display value="DAMA"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-3"/>
<display value="Normal Discharge"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-4"/>
<display value="Death"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-5"/>
<display value="DischargeToHome (Discharge disposition status)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-6"/>
<display value="DischargetoMortuary(death disposition)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-7"/>
<display value="DischargeToUnknownLocation"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-8"/>
<display value="DischargeToDifferentState"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="DIS-9"/>
<display value="DischargeToDifferentCountry"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="ONS-1"/>
<display value="Admission date -Discharge date"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="ONS-2"/>
<display value="Discharge start-discharge end time"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="ONS-3"/>
<display value="PatientNormalRoom (start datetime- enddatetime)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="ONS-4"/>
<display value="PatientEmergencyRoom(start datetime-enddatetime)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="ONS-5"/>
<display value="PatientSurgeryPerformed(startdatetime-enddatetime)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="ONS-6"/>
<display value="PatientICUStay (startdatetime-enddatetime)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REL-1"/>
<display value="ProcedurePerformedDetail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REL-2"/>
<display value="ProcedurePerformedDateTime"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REL-3"/>
<display value="ServiceRenderedDetail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REL-4"/>
<display value="ServiceRenderedDateTime"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REL-5"/>
<display value="InvestigationPerformedDetail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="REL-6"/>
<display value="InvestigationPerformedDetailDateTime"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EXC-1"/>
<display value="InsurancePolicyExclusions"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EXC-2"/>
<display value="CostlyProcedureNotCoveredInPolicy"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EXC-3"/>
<display value="ExpensiveMedicinesNotCoveredinPackage"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EXC-4"/>
<display value="ConsummablesAndDisposiblesNotcoveredinPolicy"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="EMP-1"/>
<display value="EmploymentDetail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-1"/>
<display value="Cause of Injury or Accident"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-2"/>
<display value="Patient Condition at time of admission after injury"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-3"/>
<display value="Vehicle Acident detail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-4"/>
<display value="Fire Burns detail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-5"/>
<display value="Snake Bite detail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-6"/>
<display value="Electric Shock detail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI -7"/>
<display
value="Consumption of Poisonous substance detail(FIR Registered or not)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-8"/>
<display value="Attack on human body detail (FIR Registered or not)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-9"/>
<display value="ImmediateTreatmentProvidedToPatientAfterAccident"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-10"/>
<display
value="AnyPreviousClaimsDueToAccident (previous claim details)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-11"/>
<display value="Date of Accident or Injury"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="COI-12"/>
<display value="Date-Time of Hospitalization Due to Accident"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="VRE-1"/>
<display value="EncounterDateTime"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="VRE-2"/>
<display value="EncounterType"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="VRE-3"/>
<display value="ReasonCodes (encounter reason)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="VRE-4"/>
<display value="EncounterOutcome"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CRD-1"/>
<display value="Claim received date time"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CRD-2"/>
<display value="document details (submitted with claims)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="CRD-3"/>
<display value="courier number of claim reciept"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-1"/>
<display value="MLC Case (Boolean Y/N)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-2"/>
<display value="MultiPayorClaim (Boolean Y/N)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-3"/>
<display
value="Primary and Secondary Payor Details (in case of Multi Payor claims)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-4"/>
<display value="PrimaryorSecondaryClaim"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-5"/>
<display
value="Details of claim settled by primary payor (in case of secondary claims - attachment)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-6"/>
<display
value="PMJAYInsurancePortabilityCase (Y/N) (treatment received in a different state)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-7"/>
<display
value="PrimarySHADetails (SHA/TPA detail of state where PMJAY benefeciary belongs to)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-8"/>
<display
value="SecondarySHADetails (SHA/TPA detail of state where benefeciary received treatment)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-9"/>
<display value="EmploymentImpacted (Y/N) for long disabilities)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-10"/>
<display value="Employment impacted period (start date - end date)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="IND-11"/>
<display
value="HospitalizedIndicator (if patient was hospitalized or not - Y/N)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="MAT-1"/>
<display value="Materials Forwarded"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="NMI-1"/>
<display value="Claim query detail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="TRD-1"/>
<display value="Treatment detail"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-1"/>
<display
value="additional info related to claim ( conveying additional situation and condition information.)"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-2"/>
<display value="Family Physician Name"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-3"/>
<display value="Family Physician Contact"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-4"/>
<display value="Family Physician Number"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-5"/>
<display value="Insurance Number"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-6"/>
<display value="Insurance Company"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-7"/>
<display value="Employee ID"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-8"/>
<display value="Employer Name"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-9"/>
<display value="Hospital Name"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-10"/>
<display value="Rohini ID"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-11"/>
<display value="Email"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-11"/>
<display value="Name of Insurance Company"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-12"/>
<display value="Name of TPA"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-13"/>
<display value="Proposer Name"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-14"/>
<display value="Patient's Member ID"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-15"/>
<display value="Relation with Proposer"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-16"/>
<display value="Expected Date of Admission"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-17"/>
<display value="Policy Number"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-18"/>
<display value="Expected Date of Discharge"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-19"/>
<display value="Room category"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-20"/>
<display
value="Eligible Room Category as per T&C of Policy Contract"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-21"/>
<display value="Provisional Diagnosis"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-22"/>
<display value="Proposed line of treatment"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-23"/>
<display value="Estimated Length of stay"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="TRD-2"/>
<display value="Medical Management"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="TRD-3"/>
<display value="Surgical Management"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="TRD-4"/>
<display value="Intensive Care"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="TRD-5"/>
<display value="Investigation"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="TRD-6"/>
<display value="Non allopathic treatment"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-24"/>
<display value="Name of treating Doctor"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-25"/>
<display value="Qualitifcation"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="INF-26"/>
<display value="Registation Number"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="PoPr.locationPhoto"/>
<display value="Photo of the location with subject"/>
</contains>
<contains>
<system
value="http://hcxprotocol.io/codes/claim-supporting-info-codes"/>
<code value="PoPr.deviceLocation"/>
<display value="Real time geolocation from certified devices"/>
</contains>
</expansion>
</ValueSet>
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.7.0 based on FHIR 4.0.1. Generated 2022-11-04
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