FHIR Implementation Guide for HCX
0.8.0 - CI Build
FHIR Implementation Guide for HCX
0.8.0 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.8.0). See the Directory of published versions
@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:ValueSet ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "claim-supporting-info-codes"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<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>"
] ; #
fhir:url [ fhir:v "https://ig.hcxprotocol.io/v0.8/ValueSet-claim-supporting-info-codes.html"^^xsd:anyURI] ; #
fhir:version [ fhir:v "0.8.0"] ; #
fhir:name [ fhir:v "ClaimSupportingInfoCodes"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:date [ fhir:v "2022-08-01"^^xsd:date] ; #
fhir:publisher [ fhir:v "HCX Open Community"] ; #
fhir:contact ( [
fhir:name [ fhir:v "HCX Open Community" ] ;
( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hcxprotocol.io/" ] ] )
] ) ; #
fhir:description [ fhir:v "This is the value set for the codes of different supporting information that can be shared along with the submission of a claim"] ; #
fhir:expansion [
fhir:timestamp [ fhir:v "2022-08-01T08:15:30+05:30"^^xsd:dateTime ] ;
( fhir:contains [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-1" ] ;
fhir:display [ fhir:v "Aadhar Identity Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-2" ] ;
fhir:display [ fhir:v "Passport" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-3" ] ;
fhir:display [ fhir:v "Driving License" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-4" ] ;
fhir:display [ fhir:v "Election Commision's Voter ID card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-5" ] ;
fhir:display [ fhir:v "Income Tax PAN Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-6" ] ;
fhir:display [ fhir:v "Photo Credit Card/ Debit card (with Photo)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-7" ] ;
fhir:display [ fhir:v "ECHS / CGHS Card having photo" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-8" ] ;
fhir:display [ fhir:v "Domicile Certificate / Caste Certificate with photograph" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-9" ] ;
fhir:display [ fhir:v "Current passbook of Post Office / Govt. /PSU Bank/private banks" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-10" ] ;
fhir:display [ fhir:v "Student ID card of the Govt. recognized educational institutions with photograph on it." ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-11" ] ;
fhir:display [ fhir:v "Ration Card with photograph & address. (Issued from Maharashtra state not valid )" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-12" ] ;
fhir:display [ fhir:v "Smart Card issued by CSD, Defence / Paramilitary Forces" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-13" ] ;
fhir:display [ fhir:v "Arms License" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-14" ] ;
fhir:display [ fhir:v "Senior Citizen Card having photo issued by the Govt." ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-15" ] ;
fhir:display [ fhir:v "Pensioners Card having photo issued by the Govt." ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-16" ] ;
fhir:display [ fhir:v "ID Card issued to Tibetan (Refugees) Citizens by State Govt. / Central Govt. of India having photo" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-17" ] ;
fhir:display [ fhir:v "Defence Personnel - Armed Forces ;Certificate from Competent Unit Authority" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-18" ] ;
fhir:display [ fhir:v "Certificate of Address having Photo, issued by MP/ MLA / Group A Gazetted Officer on letter head with seal" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-19" ] ;
fhir:display [ fhir:v "Certificate of address with photo from Govt. recognized educational institution (for students only)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-20" ] ;
fhir:display [ fhir:v "Certificate of Address having Photo, issued by Head of Village / Gram Panchayat or its equivalent Authority. (for Rural Areas)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-21" ] ;
fhir:display [ fhir:v "Address Card with Photo issued by Dept. of Posts" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-23" ] ;
fhir:display [ fhir:v "Freedom fighter card with photo" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POI-24" ] ;
fhir:display [ fhir:v "Kissan Passbook with photo" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-1" ] ;
fhir:display [ fhir:v "Aadhaar Identity Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-2" ] ;
fhir:display [ fhir:v "Attachment" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-3" ] ;
fhir:display [ fhir:v "Passport" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-4" ] ;
fhir:display [ fhir:v "Driving License (Issued from Maharashtra state not valid )" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-5" ] ;
fhir:display [ fhir:v "Election Commission’s Voter ID Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-6" ] ;
fhir:display [ fhir:v "Vehicle Registration Certificate / Smart card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-7" ] ;
fhir:display [ fhir:v "Water Bill with address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-8" ] ;
fhir:display [ fhir:v "Electricity Bill of Govt./private company (not older than 3 months)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-9" ] ;
fhir:display [ fhir:v "Telephone Bill of a fixed line. (Any Service Provider)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-10" ] ;
fhir:display [ fhir:v "Registered Sale/Lease (Rent) Agreement" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-11" ] ;
fhir:display [ fhir:v "Credit card statement with address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-12" ] ;
fhir:display [ fhir:v "Ration Card with photograph. (Issued from Maharashtra state not valid )" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-13" ] ;
fhir:display [ fhir:v "Certificate of address with photo from Govt. recognized educational institution (for students only)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-14" ] ;
fhir:display [ fhir:v "Current passbook of Post Office / Govt./PSU/private banks with complete address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-15" ] ;
fhir:display [ fhir:v "IT Assessment Order" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-16" ] ;
fhir:display [ fhir:v "ECHS / CGHS Card having photo & address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-17" ] ;
fhir:display [ fhir:v "Domicile Certificate / Caste Certificate with photograph & address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-18" ] ;
fhir:display [ fhir:v "Arms License" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-19" ] ;
fhir:display [ fhir:v "Senior Citizen Card having photo & address issued by the Govt." ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-20" ] ;
fhir:display [ fhir:v "Pensioners Card having photo & address issued by the Govt." ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-21" ] ;
fhir:display [ fhir:v "ID Card issued to Tibetan (Refugees) Citizens by State Govt. / Central Govt. of India having photo & address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-22" ] ;
fhir:display [ fhir:v "Defence Personnel – Armed Forces ;Certificate from Competent Unit Authority" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-23" ] ;
fhir:display [ fhir:v "Certificate of Address having Photo, issued by MP/ MLA / Group A Gazetted Officer on letter head with seal" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-24" ] ;
fhir:display [ fhir:v "Certificate of Address having Photo, issued by Head of Village / Gram Panchayat or its equivalent Authority. (for Rural Areas)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-25" ] ;
fhir:display [ fhir:v "Address Card with Photo issued by Dept. of Posts" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-26" ] ;
fhir:display [ fhir:v "Freedom fighter card with photo & address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-27" ] ;
fhir:display [ fhir:v "Kissan Passbook with photo & address" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POA-28" ] ;
fhir:display [ fhir:v "Surrender ID Card (BLT etc.) issued by Govt. of India & signed by IGP of the state" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-1" ] ;
fhir:display [ fhir:v "PDS Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-2" ] ;
fhir:display [ fhir:v "MNREGA Job Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-3" ] ;
fhir:display [ fhir:v "CGHS/ State Government/ ECHS/ ESIC Medical card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-4" ] ;
fhir:display [ fhir:v "Pension Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-5" ] ;
fhir:display [ fhir:v "Army Canteen Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-6" ] ;
fhir:display [ fhir:v "Passport" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-7" ] ;
fhir:display [ fhir:v "Birth Certificate issued by Registrar of Birth, Municipal Corporation and other notified local government bodies like Taluk, Tehsil etc." ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-8" ] ;
fhir:display [ fhir:v "Any other Central/ State government issued family entitlement document" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-9" ] ;
fhir:display [ fhir:v "Marriage Certificate issued by the government" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-10" ] ;
fhir:display [ fhir:v "Address card having name and photo issued by Department of Posts" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-11" ] ;
fhir:display [ fhir:v "Bhamashah Card/Jan-Aadhaar card issued by Govt. of Rajasthan" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-12" ] ;
fhir:display [ fhir:v "Discharge card/ slip issued by Government hospitals for birth of a child" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-13" ] ;
fhir:display [ fhir:v "Certificate of Identity having photo issued by MP or MLA or MLC or Municipal Councillor or Gazetted Officer on UIDAI standard certificate format" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "POR-14" ] ;
fhir:display [ fhir:v "Certificate of Identity having photo and relationship with HoF issued by Village Panchayat Head or Mukhiya or its equivalent authority (for rural areas)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-1" ] ;
fhir:display [ fhir:v "Birth Certificate issued by Registrar of Birth, Municipal Corporation and other notified local government bodies like Taluk, Tehsil etc." ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-2" ] ;
fhir:display [ fhir:v "SSLC Book/ Certificate" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-3" ] ;
fhir:display [ fhir:v "Passport" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-4" ] ;
fhir:display [ fhir:v "Certificate of Date of Birth issued by Group A Gazetted Officer on UIDAI standard certificate format" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-5" ] ;
fhir:display [ fhir:v "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" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-6" ] ;
fhir:display [ fhir:v "Photo ID card having Date of Birth, issued by Recognized Educational Institution" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-7" ] ;
fhir:display [ fhir:v "PAN Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-8" ] ;
fhir:display [ fhir:v "Marksheet issued by any Government Board or University" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-9" ] ;
fhir:display [ fhir:v "Government Photo ID Card/ Photo Identity Card issued by PSU containing DOB" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-10" ] ;
fhir:display [ fhir:v "Central/ State Pension Payment Order" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-11" ] ;
fhir:display [ fhir:v "Central Government Health Service Scheme Photo Card or Ex-Servicemen Contributory Health Scheme Photo card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-12" ] ;
fhir:display [ fhir:v "School Leaving Certificate (SLC)/ School Transfer Certificate (TC), containing Name and Date of Birth" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-13" ] ;
fhir:display [ fhir:v "Extract of School Records issued by Head of School containing Name, Date of Birth and Photograph" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-14" ] ;
fhir:display [ fhir:v "Certificate of Identity containing Name, DOB and Photo issued by Recognized Educational Institution signed by Head of Institute on UIDAI standard certificate format" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DOB-15" ] ;
fhir:display [ fhir:v "Certificate of identity containing Name, DOB and Photograph issued by Employees’ Provident Fund Organisation (EPFO) on UIDAI standard certificate format" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PHT-1" ] ;
fhir:display [ fhir:v "Photograph of self" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PHT-2" ] ;
fhir:display [ fhir:v "Photograph of family" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PHT-3" ] ;
fhir:display [ fhir:v "Photograph of dead person" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PHT-4" ] ;
fhir:display [ fhir:v "Photograph (any other required for claims adjudication)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "BVC-1" ] ;
fhir:display [ fhir:v "PMJAY Beneficiary Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "BVC-2" ] ;
fhir:display [ fhir:v "Insurance Card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "BVC-3" ] ;
fhir:display [ fhir:v "Employment ID card (for corporate cases)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "BVC-4" ] ;
fhir:display [ fhir:v "ESHS/ESI card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "BVC-5" ] ;
fhir:display [ fhir:v "Bhamashah Card or any other Insurance scheme card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DEF-1" ] ;
fhir:display [ fhir:v "Self signed declaration form" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DEF-2" ] ;
fhir:display [ fhir:v "Hospital stamped and signed hospital declaration form" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DEF-3" ] ;
fhir:display [ fhir:v "Any other consent form or miscellaneous declaration form" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SIG-1" ] ;
fhir:display [ fhir:v "self signature (wet signature) scanned copy" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SIG-2" ] ;
fhir:display [ fhir:v "hospital signature and stamp (scanned copy)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "FCF-1" ] ;
fhir:display [ fhir:v "duly signed filled Preauthorization form (scan)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "FCF-2" ] ;
fhir:display [ fhir:v "duly signed filled Claim form (scan)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CER" ] ;
fhir:display [ fhir:v "Medical Certificate" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MB-1" ] ;
fhir:display [ fhir:v "Final Bill" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MB-2" ] ;
fhir:display [ fhir:v "Interim Bill" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MB-3" ] ;
fhir:display [ fhir:v "Estimate Bill" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIA-1" ] ;
fhir:display [ fhir:v "Lab Investigation Report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIA-2" ] ;
fhir:display [ fhir:v "Radiology Report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIA-3" ] ;
fhir:display [ fhir:v "Imaging Report with studies" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIA-4" ] ;
fhir:display [ fhir:v "Genetic Assessment Report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "HDS-1" ] ;
fhir:display [ fhir:v "Discharge Summary Report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "HDS-2" ] ;
fhir:display [ fhir:v "Death Summary Report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "HDS-3" ] ;
fhir:display [ fhir:v "Discharge Summary with LAMA/DAMA" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REF-1" ] ;
fhir:display [ fhir:v "CGHS Refferal Letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REF-2" ] ;
fhir:display [ fhir:v "ECHS/ESI Doctor Referral Letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REF-3" ] ;
fhir:display [ fhir:v "Doctor Referral letter (to specialist)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REF-4" ] ;
fhir:display [ fhir:v "Upward Referral Letter (referral from HWC, SC, PHC,CHC to District Hospital)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REF-5" ] ;
fhir:display [ fhir:v "Downward Referral Letter (referral from higher facility to the original referee facility)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REF-6" ] ;
fhir:display [ fhir:v "Inter Hospital Referral Letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REF-7" ] ;
fhir:display [ fhir:v "Doctor Referral letter (to hospital)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DEL-1" ] ;
fhir:display [ fhir:v "Doctor signed treatment extension letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DEL-2" ] ;
fhir:display [ fhir:v "Doctor signed discharge extension letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DEL-3" ] ;
fhir:display [ fhir:v "post discharge readmission request letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-1" ] ;
fhir:display [ fhir:v "Doctor Prescription" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-2" ] ;
fhir:display [ fhir:v "Consultation Summary Note" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-3" ] ;
fhir:display [ fhir:v "Daily progress note" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-4" ] ;
fhir:display [ fhir:v "Nursing notes" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-5" ] ;
fhir:display [ fhir:v "OT Surgery Notes" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-6" ] ;
fhir:display [ fhir:v "Flowsheet" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-7" ] ;
fhir:display [ fhir:v "ICU monitoring reports with notes" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-8" ] ;
fhir:display [ fhir:v "Medication Diapensation Notes" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-9" ] ;
fhir:display [ fhir:v "CarePlan" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-10" ] ;
fhir:display [ fhir:v "Emergency Treatment Notes" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-11" ] ;
fhir:display [ fhir:v "Bedside monitoring report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CD-12" ] ;
fhir:display [ fhir:v "Point of care testing report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EID-1" ] ;
fhir:display [ fhir:v "Employment ID card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EID-2" ] ;
fhir:display [ fhir:v "CGHS card or Pension document" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EID-3" ] ;
fhir:display [ fhir:v "ECHS service card" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "FIR-1" ] ;
fhir:display [ fhir:v "FIR report" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CIL-1" ] ;
fhir:display [ fhir:v "Preauthorization approval letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CIL-2" ] ;
fhir:display [ fhir:v "Claim approval letter" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CIL- 3" ] ;
fhir:display [ fhir:v "Treatment Authorization latter from employer(for public and private sector employees,CGHS, ECHS employees)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-1" ] ;
fhir:display [ fhir:v "LAMA" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-2" ] ;
fhir:display [ fhir:v "DAMA" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-3" ] ;
fhir:display [ fhir:v "Normal Discharge" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-4" ] ;
fhir:display [ fhir:v "Death" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-5" ] ;
fhir:display [ fhir:v "DischargeToHome (Discharge disposition status)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-6" ] ;
fhir:display [ fhir:v "DischargetoMortuary(death disposition)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-7" ] ;
fhir:display [ fhir:v "DischargeToUnknownLocation" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-8" ] ;
fhir:display [ fhir:v "DischargeToDifferentState" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DIS-9" ] ;
fhir:display [ fhir:v "DischargeToDifferentCountry" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ONS-1" ] ;
fhir:display [ fhir:v "Admission date -Discharge date" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ONS-2" ] ;
fhir:display [ fhir:v "Discharge start-discharge end time" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ONS-3" ] ;
fhir:display [ fhir:v "PatientNormalRoom (start datetime- enddatetime)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ONS-4" ] ;
fhir:display [ fhir:v "PatientEmergencyRoom(start datetime-enddatetime)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ONS-5" ] ;
fhir:display [ fhir:v "PatientSurgeryPerformed(startdatetime-enddatetime)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ONS-6" ] ;
fhir:display [ fhir:v "PatientICUStay (startdatetime-enddatetime)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REL-1" ] ;
fhir:display [ fhir:v "ProcedurePerformedDetail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REL-2" ] ;
fhir:display [ fhir:v "ProcedurePerformedDateTime" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REL-3" ] ;
fhir:display [ fhir:v "ServiceRenderedDetail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REL-4" ] ;
fhir:display [ fhir:v "ServiceRenderedDateTime" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REL-5" ] ;
fhir:display [ fhir:v "InvestigationPerformedDetail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "REL-6" ] ;
fhir:display [ fhir:v "InvestigationPerformedDetailDateTime" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EXC-1" ] ;
fhir:display [ fhir:v "InsurancePolicyExclusions" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EXC-2" ] ;
fhir:display [ fhir:v "CostlyProcedureNotCoveredInPolicy" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EXC-3" ] ;
fhir:display [ fhir:v "ExpensiveMedicinesNotCoveredinPackage" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EXC-4" ] ;
fhir:display [ fhir:v "ConsummablesAndDisposiblesNotcoveredinPolicy" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EMP-1" ] ;
fhir:display [ fhir:v "EmploymentDetail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-1" ] ;
fhir:display [ fhir:v "Cause of Injury or Accident" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-2" ] ;
fhir:display [ fhir:v "Patient Condition at time of admission after injury" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-3" ] ;
fhir:display [ fhir:v "Vehicle Acident detail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-4" ] ;
fhir:display [ fhir:v "Fire Burns detail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-5" ] ;
fhir:display [ fhir:v "Snake Bite detail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-6" ] ;
fhir:display [ fhir:v "Electric Shock detail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI -7" ] ;
fhir:display [ fhir:v "Consumption of Poisonous substance detail(FIR Registered or not)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-8" ] ;
fhir:display [ fhir:v "Attack on human body detail (FIR Registered or not)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-9" ] ;
fhir:display [ fhir:v "ImmediateTreatmentProvidedToPatientAfterAccident" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-10" ] ;
fhir:display [ fhir:v "AnyPreviousClaimsDueToAccident (previous claim details)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-11" ] ;
fhir:display [ fhir:v "Date of Accident or Injury" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COI-12" ] ;
fhir:display [ fhir:v "Date-Time of Hospitalization Due to Accident" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "VRE-1" ] ;
fhir:display [ fhir:v "EncounterDateTime" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "VRE-2" ] ;
fhir:display [ fhir:v "EncounterType" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "VRE-3" ] ;
fhir:display [ fhir:v "ReasonCodes (encounter reason)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "VRE-4" ] ;
fhir:display [ fhir:v "EncounterOutcome" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CRD-1" ] ;
fhir:display [ fhir:v "Claim received date time" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CRD-2" ] ;
fhir:display [ fhir:v "document details (submitted with claims)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CRD-3" ] ;
fhir:display [ fhir:v "courier number of claim reciept" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-1" ] ;
fhir:display [ fhir:v "MLC Case (Boolean Y/N)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-2" ] ;
fhir:display [ fhir:v "MultiPayorClaim (Boolean Y/N)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-3" ] ;
fhir:display [ fhir:v "Primary and Secondary Payor Details (in case of Multi Payor claims)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-4" ] ;
fhir:display [ fhir:v "PrimaryorSecondaryClaim" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-5" ] ;
fhir:display [ fhir:v "Details of claim settled by primary payor (in case of secondary claims - attachment)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-6" ] ;
fhir:display [ fhir:v "PMJAYInsurancePortabilityCase (Y/N) (treatment received in a different state)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-7" ] ;
fhir:display [ fhir:v "PrimarySHADetails (SHA/TPA detail of state where PMJAY benefeciary belongs to)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-8" ] ;
fhir:display [ fhir:v "SecondarySHADetails (SHA/TPA detail of state where benefeciary received treatment)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-9" ] ;
fhir:display [ fhir:v "EmploymentImpacted (Y/N) for long disabilities)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-10" ] ;
fhir:display [ fhir:v "Employment impacted period (start date - end date)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "IND-11" ] ;
fhir:display [ fhir:v "HospitalizedIndicator (if patient was hospitalized or not - Y/N)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MAT-1" ] ;
fhir:display [ fhir:v "Materials Forwarded" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NMI-1" ] ;
fhir:display [ fhir:v "Claim query detail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TRD-1" ] ;
fhir:display [ fhir:v "Treatment detail" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-1" ] ;
fhir:display [ fhir:v "additional info related to claim ( conveying additional situation and condition information.)" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-2" ] ;
fhir:display [ fhir:v "Family Physician Name" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-3" ] ;
fhir:display [ fhir:v "Family Physician Contact" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-4" ] ;
fhir:display [ fhir:v "Family Physician Number" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-5" ] ;
fhir:display [ fhir:v "Insurance Number" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-6" ] ;
fhir:display [ fhir:v "Insurance Company" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-7" ] ;
fhir:display [ fhir:v "Employee ID" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-8" ] ;
fhir:display [ fhir:v "Employer Name" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-9" ] ;
fhir:display [ fhir:v "Hospital Name" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-10" ] ;
fhir:display [ fhir:v "Rohini ID" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-11" ] ;
fhir:display [ fhir:v "Email" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-11" ] ;
fhir:display [ fhir:v "Name of Insurance Company" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-12" ] ;
fhir:display [ fhir:v "Name of TPA" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-13" ] ;
fhir:display [ fhir:v "Proposer Name" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-14" ] ;
fhir:display [ fhir:v "Patient's Member ID" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-15" ] ;
fhir:display [ fhir:v "Relation with Proposer" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-16" ] ;
fhir:display [ fhir:v "Expected Date of Admission" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-17" ] ;
fhir:display [ fhir:v "Policy Number" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-18" ] ;
fhir:display [ fhir:v "Expected Date of Discharge" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-19" ] ;
fhir:display [ fhir:v "Room category" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-20" ] ;
fhir:display [ fhir:v "Eligible Room Category as per T&C of Policy Contract" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-21" ] ;
fhir:display [ fhir:v "Provisional Diagnosis" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-22" ] ;
fhir:display [ fhir:v "Proposed line of treatment" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-23" ] ;
fhir:display [ fhir:v "Estimated Length of stay" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TRD-2" ] ;
fhir:display [ fhir:v "Medical Management" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TRD-3" ] ;
fhir:display [ fhir:v "Surgical Management" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TRD-4" ] ;
fhir:display [ fhir:v "Intensive Care" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TRD-5" ] ;
fhir:display [ fhir:v "Investigation" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TRD-6" ] ;
fhir:display [ fhir:v "Non allopathic treatment" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-24" ] ;
fhir:display [ fhir:v "Name of treating Doctor" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-25" ] ;
fhir:display [ fhir:v "Qualitifcation" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "INF-26" ] ;
fhir:display [ fhir:v "Registation Number" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PoPr.locationPhoto" ] ;
fhir:display [ fhir:v "Photo of the location with subject" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-supporting-info-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PoPr.deviceLocation" ] ;
fhir:display [ fhir:v "Real time geolocation from certified devices" ] ] )
] . #
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.8.0 based on FHIR 4.0.1. Generated 2023-03-15
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