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

: HCX Coverage Eligibility Request Document example - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Bundle;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "CoverageEligibilityRequestDocument-example-01"];
  fhir:Resource.meta [
     fhir:Meta.lastUpdated [ fhir:value "2022-02-08T21:49:55.458+05:30"^^xsd:dateTime ]
  ];
  fhir:Bundle.identifier [
     fhir:Identifier.system [ fhir:value "https://www.tmh.in/bundle" ];
     fhir:Identifier.value [ fhir:value "CoverageEligibilityRequestDocument-example-01" ]
  ];
  fhir:Bundle.type [ fhir:value "document"];
  fhir:Bundle.timestamp [ fhir:value "2022-02-08T21:49:55.458+05:30"^^xsd:dateTime];
  fhir:Bundle.entry [
     fhir:index 0;
     fhir:Bundle.entry.fullUrl [ fhir:value "Composition/42ff4a07-3e36-402f-a99e-29f16c0c9eee" ];
     fhir:Bundle.entry.resource <Composition/42ff4a07-3e36-402f-a99e-29f16c0c9eee>
  ], [
     fhir:index 1;
     fhir:Bundle.entry.fullUrl [ fhir:value "Organization/Tmh01" ];
     fhir:Bundle.entry.resource <Organization/Tmh01>
  ], [
     fhir:index 2;
     fhir:Bundle.entry.fullUrl [ fhir:value "Patient/RVH1003" ];
     fhir:Bundle.entry.resource <Patient/RVH1003>
  ], [
     fhir:index 3;
     fhir:Bundle.entry.fullUrl [ fhir:value "CoverageEligibilityRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6" ];
     fhir:Bundle.entry.resource <CoverageEligibilityRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6>
  ], [
     fhir:index 4;
     fhir:Bundle.entry.fullUrl [ fhir:value "Organization/GICOFINDIA" ];
     fhir:Bundle.entry.resource <Organization/GICOFINDIA>
  ], [
     fhir:index 5;
     fhir:Bundle.entry.fullUrl [ fhir:value "Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc" ];
     fhir:Bundle.entry.resource <Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc>
  ].

<Composition/42ff4a07-3e36-402f-a99e-29f16c0c9eee> a fhir:Composition;
  fhir:Resource.id [ fhir:value "42ff4a07-3e36-402f-a99e-29f16c0c9eee"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Composition</b><a name=\"42ff4a07-3e36-402f-a99e-29f16c0c9eee\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Composition \"42ff4a07-3e36-402f-a99e-29f16c0c9eee\" </p></div><p><b>identifier</b>: id: 42ff4a07-3e36-402f-a99e-29f16c0c9eee</p><p><b>status</b>: final</p><p><b>type</b>: Coverage Eligibility Request Doc <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (document-type#HcxCoverageEligibilityRequest)</span></p><p><b>date</b>: 2022-02-08 09:49:55+0530</p><p><b>author</b>: <a href=\"#Organization_Tmh01\">See above (Organization/Tmh01)</a></p><p><b>title</b>: Coverage Eligibility Request</p></div>"
  ];
  fhir:Composition.identifier [
     fhir:Identifier.system [ fhir:value "https://www.tmh.in/hcx-documents" ];
     fhir:Identifier.value [ fhir:value "42ff4a07-3e36-402f-a99e-29f16c0c9eee" ]
  ];
  fhir:Composition.status [ fhir:value "final"];
  fhir:Composition.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "https://www.hcx.org/document-type" ];
       fhir:Coding.code [ fhir:value "HcxCoverageEligibilityRequest" ];
       fhir:Coding.display [ fhir:value "Coverage Eligibility Request Doc" ]     ]
  ];
  fhir:Composition.subject [
     fhir:Reference.reference [ fhir:value "Patient/RVH1003" ]
  ];
  fhir:Composition.date [ fhir:value "2022-02-08T21:49:55+05:30"^^xsd:dateTime];
  fhir:Composition.author [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Organization/Tmh01" ]
  ];
  fhir:Composition.title [ fhir:value "Coverage Eligibility Request"];
  fhir:Composition.section [
     fhir:index 0;
     fhir:Composition.section.title [ fhir:value "# Eligibility Request" ];
     fhir:Composition.section.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ValueSet/resource-types" ];
         fhir:Coding.code [ fhir:value "CoverageEligibilityRequest" ];
         fhir:Coding.display [ fhir:value "Coverage Eligibility Request" ]       ];
       fhir:CodeableConcept.text [ fhir:value "CoverageEligibilityRequest" ]     ];
     fhir:Composition.section.entry [
       fhir:index 0;
       fhir:Reference.reference [ fhir:value "CoverageEligibilityRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6" ]     ]
  ].

<Organization/Tmh01> a fhir:Organization;
  fhir:Resource.id [ fhir:value "Tmh01"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"Tmh01\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Organization \"Tmh01\" </p></div><p><b>identifier</b>: id: HFR-ID-FOR-TMH, id: IRDA-ID-FOR-TMH</p><p><b>name</b>: Tata Memorial Hospital</p><p><b>alias</b>: TMH, TMC</p><p><b>telecom</b>: ph: (+91) 022-2417-7000</p><p><b>address</b>: Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012 Mumbai Maharashtra 400012 INDIA </p><p><b>endpoint</b>: <a href=\"https://www.tmc.gov.in/\">https://www.tmc.gov.in/: Website</a></p></div>"
  ];
  fhir:Organization.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://abdm.gov.in/facilities" ];
     fhir:Identifier.value [ fhir:value "HFR-ID-FOR-TMH" ]
  ], [
     fhir:index 1;
     fhir:Identifier.system [ fhir:value "http://irdai.gov.in/facilities" ];
     fhir:Identifier.value [ fhir:value "IRDA-ID-FOR-TMH" ]
  ];
  fhir:Organization.name [ fhir:value "Tata Memorial Hospital"];
  fhir:Organization.alias [
     fhir:value "TMH";
     fhir:index 0
  ], [
     fhir:value "TMC";
     fhir:index 1
  ];
  fhir:Organization.telecom [
     fhir:index 0;
     fhir:ContactPoint.system [ fhir:value "phone" ];
     fhir:ContactPoint.value [ fhir:value "(+91) 022-2417-7000" ]
  ];
  fhir:Organization.address [
     fhir:index 0;
     fhir:Address.line [
       fhir:value "Dr Ernest Borges Rd, Parel East, Parel, Mumbai, Maharashtra 400012";
       fhir:index 0     ];
     fhir:Address.city [ fhir:value "Mumbai" ];
     fhir:Address.state [ fhir:value "Maharashtra" ];
     fhir:Address.postalCode [ fhir:value "400012" ];
     fhir:Address.country [ fhir:value "INDIA" ]
  ];
  fhir:Organization.endpoint [
     fhir:index 0;
     fhir:link <https://www.tmc.gov.in/>;
     fhir:Reference.reference [ fhir:value "https://www.tmc.gov.in/" ];
     fhir:Reference.display [ fhir:value "Website" ]
  ].

<Patient/RVH1003> a fhir:Patient;
  fhir:Resource.id [ fhir:value "RVH1003"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Patient</b><a name=\"RVH1003\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Patient \"RVH1003\" </p></div><p><b>identifier</b>: Subscriber Number: BEN-101, id: hinapatel@abdm</p><p><b>name</b>: Hina Patel</p><p><b>gender</b>: female</p></div>"
  ];
  fhir:Patient.identifier [
     fhir:index 0;
     fhir:Identifier.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
         fhir:Coding.code [ fhir:value "SN" ];
         fhir:Coding.display [ fhir:value "Subscriber Number" ]       ]     ];
     fhir:Identifier.system [ fhir:value "http://gicofIndia.com/beneficiaries" ];
     fhir:Identifier.value [ fhir:value "BEN-101" ]
  ], [
     fhir:index 1;
     fhir:Identifier.system [ fhir:value "http://abdm.gov.in/patients" ];
     fhir:Identifier.value [ fhir:value "hinapatel@abdm" ]
  ];
  fhir:Patient.name [
     fhir:index 0;
     fhir:HumanName.text [ fhir:value "Hina Patel" ]
  ];
  fhir:Patient.gender [ fhir:value "female"].

<CoverageEligibilityRequest/dc82673b-8c71-48c2-8a17-16dcb3b035f6> a fhir:CoverageEligibilityRequest;
  fhir:Resource.id [ fhir:value "dc82673b-8c71-48c2-8a17-16dcb3b035f6"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: CoverageEligibilityRequest</b><a name=\"dc82673b-8c71-48c2-8a17-16dcb3b035f6\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource CoverageEligibilityRequest \"dc82673b-8c71-48c2-8a17-16dcb3b035f6\" </p></div><p><b>identifier</b>: id: dc82673b-8c71-48c2-8a17-16dcb3b035f6</p><p><b>status</b>: active</p><p><b>purpose</b>: discovery</p><p><b>patient</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>serviced</b>: 2022-02-07 09:49:56+0530 --&gt; 2022-02-09 09:49:56+0530</p><p><b>created</b>: 2022-02-08 09:49:56+0530</p><p><b>provider</b>: <a href=\"#Organization_Tmh01\">See above (Organization/Tmh01)</a></p><p><b>insurer</b>: <a href=\"#Organization_GICOFINDIA\">See above (Organization/GICOFINDIA)</a></p><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><a href=\"#Coverage_dadde132-ad64-4d18-8c18-1d52d7e86abc\">See above (Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc)</a></td></tr></table></div>"
  ];
  fhir:CoverageEligibilityRequest.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "https://www.tmh.in/coverage-eligibility-request" ];
     fhir:Identifier.value [ fhir:value "dc82673b-8c71-48c2-8a17-16dcb3b035f6" ]
  ];
  fhir:CoverageEligibilityRequest.status [ fhir:value "active"];
  fhir:CoverageEligibilityRequest.purpose [
     fhir:value "discovery";
     fhir:index 0
  ];
  fhir:CoverageEligibilityRequest.patient [
     fhir:Reference.reference [ fhir:value "Patient/RVH1003" ]
  ];
  fhir:CoverageEligibilityRequest.servicedPeriod [
     fhir:Period.start [ fhir:value "2022-02-07T21:49:56+05:30"^^xsd:dateTime ];
     fhir:Period.end [ fhir:value "2022-02-09T21:49:56+05:30"^^xsd:dateTime ]
  ];
  fhir:CoverageEligibilityRequest.created [ fhir:value "2022-02-08T21:49:56+05:30"^^xsd:dateTime];
  fhir:CoverageEligibilityRequest.provider [
     fhir:Reference.reference [ fhir:value "Organization/Tmh01" ]
  ];
  fhir:CoverageEligibilityRequest.insurer [
     fhir:Reference.reference [ fhir:value "Organization/GICOFINDIA" ]
  ];
  fhir:CoverageEligibilityRequest.insurance [
     fhir:index 0;
     fhir:CoverageEligibilityRequest.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:CoverageEligibilityRequest.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc" ]     ]
  ].

<Organization/GICOFINDIA> a fhir:Organization;
  fhir:Resource.id [ fhir:value "GICOFINDIA"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Organization</b><a name=\"GICOFINDIA\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Organization \"GICOFINDIA\" </p></div><p><b>identifier</b>: id: 112</p><p><b>name</b>: General Insurance Corporation of India</p></div>"
  ];
  fhir:Organization.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://irdai.gov.in/insurers" ];
     fhir:Identifier.value [ fhir:value "112" ]
  ];
  fhir:Organization.name [ fhir:value "General Insurance Corporation of India"].

<Coverage/dadde132-ad64-4d18-8c18-1d52d7e86abc> a fhir:Coverage;
  fhir:Resource.id [ fhir:value "dadde132-ad64-4d18-8c18-1d52d7e86abc"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Coverage</b><a name=\"dadde132-ad64-4d18-8c18-1d52d7e86abc\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Coverage \"dadde132-ad64-4d18-8c18-1d52d7e86abc\" </p></div><p><b>identifier</b>: id: policy-RVH1003</p><p><b>status</b>: active</p><p><b>subscriber</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>subscriberId</b>: SN-RVH1003</p><p><b>beneficiary</b>: <a href=\"#Patient_RVH1003\">See above (Patient/RVH1003)</a></p><p><b>relationship</b>: self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (subscriber-relationship#self)</span></p><p><b>payor</b>: <a href=\"#Organization_GICOFINDIA\">See above (Organization/GICOFINDIA)</a></p></div>"
  ];
  fhir:Coverage.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "https://www.gicofIndia.in/policies" ];
     fhir:Identifier.value [ fhir:value "policy-RVH1003" ]
  ];
  fhir:Coverage.status [ fhir:value "active"];
  fhir:Coverage.subscriber [
     fhir:Reference.reference [ fhir:value "Patient/RVH1003" ]
  ];
  fhir:Coverage.subscriberId [ fhir:value "SN-RVH1003"];
  fhir:Coverage.beneficiary [
     fhir:Reference.reference [ fhir:value "Patient/RVH1003" ]
  ];
  fhir:Coverage.relationship [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ValueSet/subscriber-relationship" ];
       fhir:Coding.code [ fhir:value "self" ]     ]
  ];
  fhir:Coverage.payor [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Organization/GICOFINDIA" ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.