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

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: CoverageEligibilityRequest/benefits-example-01 - JSON Representation

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{
  "resourceType" : "CoverageEligibilityRequest",
  "id" : "benefits-example-01",
  "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\"><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityRequest benefits-example-01</b></p><a name=\"benefits-example-01\"> </a><a name=\"hcbenefits-example-01\"> </a><a name=\"benefits-example-01-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 benefits</p><p><b>patient</b>: <a href=\"Patient-example-01.html\">ABC Male, DoB: 1981-01-12 ( Medical record number: 22-7225-4829-5255)</a></p><p><b>created</b>: 2023-09-07 11:01:00+0500</p><p><b>enterer</b>: <a href=\"Practitioner-example-01.html\">Practitioner Dr. DEF</a></p><p><b>provider</b>: <a href=\"Practitioner-example-01.html\">Practitioner Dr. DEF</a></p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</a></p><p><b>facility</b>: <a href=\"Location-example-03.html\">Location South Wing, second floor</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=\"Coverage-example-01.html\">Coverage: identifier = https://xyzinsurance.in/policynumber/#235037120; status = active; type = PAY; subscriberId = ABC123456BI007; relationship = Self; period = (?) --&gt; 2026-03-17</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" : [
    "benefits"
  ],
  "patient" : {
    🔗 "reference" : "Patient/example-01"
  },
  "created" : "2023-09-07T11:01:00+05:00",
  "enterer" : {
    🔗 "reference" : "Practitioner/example-01"
  },
  "provider" : {
    🔗 "reference" : "Practitioner/example-01"
  },
  "insurer" : {
    🔗 "reference" : "Organization/example-02"
  },
  "facility" : {
    🔗 "reference" : "Location/example-03"
  },
  "insurance" : [
    {
      "focal" : true,
      "coverage" : {
        🔗 "reference" : "Coverage/example-01"
      }
    }
  ],
  "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"
              }
            ]
          }
        }
      ]
    }
  ]
}