FHIR Implementation Guide for ABDM
6.5.0 - active
FHIR Implementation Guide for ABDM
6.5.0 - active
This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "CoverageEligibilityRequestBundle-auth-requirement-example-01",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityRequestBundle"
]
},
"identifier" : {
"value" : "bc3c6c57-2053-4d0e-ac40-139ccccff645"
},
"type" : "collection",
"timestamp" : "2025-03-07T15:32:26.605+05:30",
"entry" : [
{
"fullUrl" : "urn:uuid:a752531b-67ad-4b33-9a8b-e1b9229d1505",
"resource" : {
"resourceType" : "CoverageEligibilityRequest",
"id" : "a752531b-67ad-4b33-9a8b-e1b9229d1505",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityRequest"
]
},
"language" : "en",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><a name=\"CoverageEligibilityRequest_a752531b-67ad-4b33-9a8b-e1b9229d1505\"> </a><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityRequest a752531b-67ad-4b33-9a8b-e1b9229d1505</b></p><a name=\"a752531b-67ad-4b33-9a8b-e1b9229d1505\"> </a><a name=\"hca752531b-67ad-4b33-9a8b-e1b9229d1505\"> </a><a name=\"a752531b-67ad-4b33-9a8b-e1b9229d1505-hi-IN\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-CoverageEligibilityRequest.html\">CoverageEligibilityRequest</a></p></div><p><b>identifier</b>: 7612345</p><p><b>status</b>: Active</p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><p><b>purpose</b>: Coverage auth-requirements</p><p><b>patient</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\">Patient</a></p><p><b>created</b>: 2025-03-07 11:01:00+0500</p><p><b>enterer</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-9ee37afe-e35a-4ee8-80b1-7f4786cdd507\">Practitioner</a></p><p><b>provider</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-48d6ee22-e2bf-427e-878a-19b5f264f46a\">Organization</a></p><p><b>insurer</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-66ec8a06-3a04-454e-bace-0ad07f70405a\">Organization</a></p><p><b>facility</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-ea4f766b-b7c1-476a-8f19-095928b65ca5\">Location</a></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-462d36b1-4171-4ebb-871d-94fdb3f7eb11\">Coverage</a></td></tr></table><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 768839008}\">Consultant</span></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 E11.9}\">Type 2 diabetes mellitus : Without complications</span></td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 765507008}\">Metformin hydrochloride 500 mg prolonged-release oral tablet</span></p><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/sid/icd-10 E11.9}\">Type 2 diabetes mellitus : Without complications</span></td></tr></table></blockquote></div>"
},
"identifier" : [
{
"value" : "7612345"
}
],
"status" : "active",
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal",
"display" : "Normal"
}
]
},
"purpose" : [
"auth-requirements"
],
"patient" : {
"reference" : "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
"display" : "Patient"
},
"created" : "2025-03-07T11:01:00+05:00",
"enterer" : {
"reference" : "urn:uuid:9ee37afe-e35a-4ee8-80b1-7f4786cdd507",
"display" : "Practitioner"
},
"provider" : {
"reference" : "urn:uuid:48d6ee22-e2bf-427e-878a-19b5f264f46a",
"display" : "Organization"
},
"insurer" : {
"reference" : "urn:uuid:66ec8a06-3a04-454e-bace-0ad07f70405a",
"display" : "Organization"
},
"facility" : {
"reference" : "urn:uuid:ea4f766b-b7c1-476a-8f19-095928b65ca5",
"display" : "Location"
},
"insurance" : [
{
"focal" : true,
"coverage" : {
"reference" : "urn:uuid:462d36b1-4171-4ebb-871d-94fdb3f7eb11",
"display" : "Coverage"
}
}
],
"item" : [
{
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "768839008",
"display" : "Consultant"
}
]
},
"diagnosis" : [
{
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10",
"code" : "E11.9",
"display" : "Type 2 diabetes mellitus : Without complications"
}
]
}
}
]
},
{
"productOrService" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "765507008",
"display" : "Metformin hydrochloride 500 mg prolonged-release oral tablet"
}
]
},
"diagnosis" : [
{
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10",
"code" : "E11.9",
"display" : "Type 2 diabetes mellitus : Without complications"
}
]
}
}
]
}
]
}
},
{
"fullUrl" : "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
"resource" : {
"resourceType" : "Patient",
"id" : "a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Patient"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient a4dbd17d-35f8-4f36-9dac-f276fa75a4c8</b></p><a name=\"a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\"> </a><a name=\"hca4dbd17d-35f8-4f36-9dac-f276fa75a4c8\"> </a><a name=\"a4dbd17d-35f8-4f36-9dac-f276fa75a4c8-hi-IN\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Adarsh Agrawal Male, DoB: 1981-01-12 ( Adhaar number: 7225-4829-5255)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><a href=\"tel:+919818512600\">+919818512600</a></td></tr></table></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ADN",
"display" : "Adhaar number"
}
]
},
"system" : "https://uidai.gov.in/",
"value" : "7225-4829-5255"
}
],
"name" : [
{
"text" : "Adarsh Agrawal"
}
],
"telecom" : [
{
"system" : "phone",
"value" : "+919818512600",
"use" : "home"
}
],
"gender" : "male",
"birthDate" : "1981-01-12"
}
},
{
"fullUrl" : "urn:uuid:9ee37afe-e35a-4ee8-80b1-7f4786cdd507",
"resource" : {
"resourceType" : "Practitioner",
"id" : "9ee37afe-e35a-4ee8-80b1-7f4786cdd507",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Practitioner"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_9ee37afe-e35a-4ee8-80b1-7f4786cdd507\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner 9ee37afe-e35a-4ee8-80b1-7f4786cdd507</b></p><a name=\"9ee37afe-e35a-4ee8-80b1-7f4786cdd507\"> </a><a name=\"hc9ee37afe-e35a-4ee8-80b1-7f4786cdd507\"> </a><a name=\"9ee37afe-e35a-4ee8-80b1-7f4786cdd507-hi-IN\"> </a><p><b>identifier</b>: Medical License number/21-1521-3828-3227</p><p><b>name</b>: Dr. Aayush Agrawal</p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MD",
"display" : "Medical License number"
}
]
},
"system" : "https://doctor.ndhm.gov.in",
"value" : "21-1521-3828-3227"
}
],
"name" : [
{
"text" : "Dr. Aayush Agrawal"
}
]
}
},
{
"fullUrl" : "urn:uuid:66ec8a06-3a04-454e-bace-0ad07f70405a",
"resource" : {
"resourceType" : "Organization",
"id" : "66ec8a06-3a04-454e-bace-0ad07f70405a",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_66ec8a06-3a04-454e-bace-0ad07f70405a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 66ec8a06-3a04-454e-bace-0ad07f70405a</b></p><a name=\"66ec8a06-3a04-454e-bace-0ad07f70405a\"> </a><a name=\"hc66ec8a06-3a04-454e-bace-0ad07f70405a\"> </a><a name=\"66ec8a06-3a04-454e-bace-0ad07f70405a-hi-IN\"> </a><p><b>identifier</b>: Registry of Hospitals in Network of Insurance (ROHINI) ID/4567878</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type ins}\">Insurance Company</span></p><p><b>name</b>: XYZ Insurance Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341234\">+91 243 2634 1234</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-identifier-type-code",
"code" : "ROHINI",
"display" : "Registry of Hospitals in Network of Insurance (ROHINI) ID"
}
]
},
"system" : "https://rohini.iib.gov.in/",
"value" : "4567878"
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "ins",
"display" : "Insurance Company"
}
]
}
],
"name" : "XYZ Insurance Co. Ltd.",
"telecom" : [
{
"system" : "phone",
"value" : "+91 243 2634 1234",
"use" : "work"
},
{
"system" : "email",
"value" : "contact@xyz.org",
"use" : "work"
}
]
}
},
{
"fullUrl" : "urn:uuid:48d6ee22-e2bf-427e-878a-19b5f264f46a",
"resource" : {
"resourceType" : "Organization",
"id" : "48d6ee22-e2bf-427e-878a-19b5f264f46a",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_48d6ee22-e2bf-427e-878a-19b5f264f46a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization 48d6ee22-e2bf-427e-878a-19b5f264f46a</b></p><a name=\"48d6ee22-e2bf-427e-878a-19b5f264f46a\"> </a><a name=\"hc48d6ee22-e2bf-427e-878a-19b5f264f46a\"> </a><a name=\"48d6ee22-e2bf-427e-878a-19b5f264f46a-hi-IN\"> </a><p><b>identifier</b>: Provider number/1234567890</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type prov}\">Healthcare Provider</span></p><p><b>name</b>: XYZ Hospital Co. Ltd.</p><p><b>telecom</b>: <a href=\"tel:+9124326341278\">+91 243 2634 1278</a>, <a href=\"mailto:contact@xyz.org\">contact@xyz.org</a></p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PRN",
"display" : "Provider number"
}
]
},
"system" : "https://facility.ndhm.gov.in",
"value" : "1234567890"
}
],
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
"code" : "prov",
"display" : "Healthcare Provider"
}
]
}
],
"name" : "XYZ Hospital Co. Ltd.",
"telecom" : [
{
"system" : "phone",
"value" : "+91 243 2634 1278",
"use" : "work"
},
{
"system" : "email",
"value" : "contact@xyz.org",
"use" : "work"
}
]
}
},
{
"fullUrl" : "urn:uuid:ea4f766b-b7c1-476a-8f19-095928b65ca5",
"resource" : {
"resourceType" : "Location",
"id" : "ea4f766b-b7c1-476a-8f19-095928b65ca5",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Location_ea4f766b-b7c1-476a-8f19-095928b65ca5\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Location ea4f766b-b7c1-476a-8f19-095928b65ca5</b></p><a name=\"ea4f766b-b7c1-476a-8f19-095928b65ca5\"> </a><a name=\"hcea4f766b-b7c1-476a-8f19-095928b65ca5\"> </a><a name=\"ea4f766b-b7c1-476a-8f19-095928b65ca5-hi-IN\"> </a><p><b>identifier</b>: B1-S.F2</p><p><b>status</b>: Active</p><p><b>name</b>: South Wing, second floor</p><p><b>alias</b>: XYZ Life Hospital Co. Ltd., South Wing, second floor</p><p><b>description</b>: Second floor of the Old South Wing, formerly in use by Psychiatry</p><p><b>mode</b>: Instance</p><p><b>telecom</b>: ph: 2328(Work), fax: 2329(Work), <a href=\"http://sampleorg.com/southwing\">http://sampleorg.com/southwing</a></p><p><b>address</b>: 91, Building A Pune 451855 IND (work)</p><p><b>physicalType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/location-physical-type wi}\">Wing</span></p><h3>Positions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Longitude</b></td><td><b>Latitude</b></td><td><b>Altitude</b></td></tr><tr><td style=\"display: none\">*</td><td>-83.6945691</td><td>42.25475478</td><td>0</td></tr></table><p><b>managingOrganization</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-48d6ee22-e2bf-427e-878a-19b5f264f46a\">Organization</a></p></div>"
},
"identifier" : [
{
"value" : "B1-S.F2"
}
],
"status" : "active",
"name" : "South Wing, second floor",
"alias" : [
"XYZ Life Hospital Co. Ltd., South Wing, second floor"
],
"description" : "Second floor of the Old South Wing, formerly in use by Psychiatry",
"mode" : "instance",
"telecom" : [
{
"system" : "phone",
"value" : "2328",
"use" : "work"
},
{
"system" : "fax",
"value" : "2329",
"use" : "work"
},
{
"system" : "url",
"value" : "http://sampleorg.com/southwing",
"use" : "work"
}
],
"address" : {
"use" : "work",
"line" : [
"91, Building A"
],
"city" : "Pune",
"postalCode" : "451855",
"country" : "IND"
},
"physicalType" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/location-physical-type",
"code" : "wi",
"display" : "Wing"
}
]
},
"position" : {
"longitude" : -83.6945691,
"latitude" : 42.25475478,
"altitude" : 0
},
"managingOrganization" : {
"reference" : "urn:uuid:48d6ee22-e2bf-427e-878a-19b5f264f46a",
"display" : "Organization"
}
}
},
{
"fullUrl" : "urn:uuid:462d36b1-4171-4ebb-871d-94fdb3f7eb11",
"resource" : {
"resourceType" : "Coverage",
"id" : "462d36b1-4171-4ebb-871d-94fdb3f7eb11",
"meta" : {
"profile" : [
🔗 "https://nrces.in/ndhm/fhir/r4/StructureDefinition/Coverage"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_462d36b1-4171-4ebb-871d-94fdb3f7eb11\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage 462d36b1-4171-4ebb-871d-94fdb3f7eb11</b></p><a name=\"462d36b1-4171-4ebb-871d-94fdb3f7eb11\"> </a><a name=\"hc462d36b1-4171-4ebb-871d-94fdb3f7eb11\"> </a><a name=\"462d36b1-4171-4ebb-871d-94fdb3f7eb11-hi-IN\"> </a><p><b>identifier</b>: <code>https://xyzinsurance.in/policynumber/</code>/235037120</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span></p><p><b>subscriber</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\">Patient</a></p><p><b>subscriberId</b>: ABC123456BI007</p><p><b>beneficiary</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-a4dbd17d-35f8-4f36-9dac-f276fa75a4c8\">Patient</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: ?? --> 2026-03-17</p><p><b>payor</b>: <a href=\"Bundle-CoverageEligibilityRequestBundle-auth-requirement-example-01.html#urn-uuid-66ec8a06-3a04-454e-bace-0ad07f70405a\">Organization</a></p></div>"
},
"identifier" : [
{
"system" : "https://xyzinsurance.in/policynumber/",
"value" : "235037120"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "HIP",
"display" : "health insurance plan policy"
}
]
},
"subscriber" : {
"reference" : "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
"display" : "Patient"
},
"subscriberId" : "ABC123456BI007",
"beneficiary" : {
"reference" : "urn:uuid:a4dbd17d-35f8-4f36-9dac-f276fa75a4c8",
"display" : "Patient"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"end" : "2026-03-17"
},
"payor" : [
{
"reference" : "urn:uuid:66ec8a06-3a04-454e-bace-0ad07f70405a",
"display" : "Organization"
}
]
}
}
]
}