FHIR Implementation Guide for ABDM
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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

: CoverageEligibilityResponse/benefits-example-01 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

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

 a fhir:CoverageEligibilityResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "benefits-example-01"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse"^^xsd:anyURI ;
fhir:link <https://nrces.in/ndhm/fhir/r4/StructureDefinition/CoverageEligibilityResponse>     ] )
  ] ; # 
  fhir:language [ fhir:v "en"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: CoverageEligibilityResponse 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-CoverageEligibilityResponse.html\">CoverageEligibilityResponse</a></p></div><p><b>status</b>: Active</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</p><p><b>requestor</b>: <a href=\"Practitioner-example-01.html\">Practitioner Dr. DEF</a></p><p><b>request</b>: <a href=\"CoverageEligibilityRequest-benefits-example-01.html\">CoverageEligibilityRequest: identifier = 7612345; status = active; priority = Normal; purpose = benefits; created = 2023-09-07 11:01:00+0500</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Policy is currently in-force.</p><p><b>insurer</b>: <a href=\"Organization-example-02.html\">Organization XYZ Insurance Co. Ltd.</a></p><blockquote><p><b>insurance</b></p><p><b>coverage</b>: <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></p><p><b>inforce</b>: true</p><p><b>benefitPeriod</b>: 2023-09-07 --&gt; 2026-08-07</p><blockquote><p><b>item</b></p><p><b>productOrService</b>: <span title=\"Codes:{http://snomed.info/sct 768839008}\">Consultant</span></p><h3>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type benefit}\">Benefit</span></td><td><span title=\"Indian Rupee\">₹50,000.00</span> (INR)</td><td><span title=\"Indian Rupee\">₹0.00</span> (INR)</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>Benefits</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-type benefit}\">Benefit</span></td><td><span title=\"Indian Rupee\">₹50,000.00</span> (INR)</td><td><span title=\"Indian Rupee\">₹0.00</span> (INR)</td></tr></table></blockquote></blockquote></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:purpose ( [ fhir:v "benefits"] ) ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/example-01" ]
  ] ; # 
  fhir:created [ fhir:v "2023-09-07"^^xsd:date] ; # 
  fhir:requestor [
fhir:reference [ fhir:v "Practitioner/example-01" ]
  ] ; # 
  fhir:request [
fhir:reference [ fhir:v "CoverageEligibilityRequest/benefits-example-01" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "Policy is currently in-force."] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/example-02" ]
  ] ; # 
  fhir:insurance ( [
fhir:coverage [
fhir:reference [ fhir:v "Coverage/example-01" ]     ] ;
fhir:inforce [ fhir:v "true"^^xsd:boolean ] ;
fhir:benefitPeriod [
fhir:start [ fhir:v "2023-09-07"^^xsd:date ] ;
fhir:end [ fhir:v "2026-08-07"^^xsd:date ]     ] ;
    ( fhir:item [
fhir:productOrService [
        ( fhir:coding [
a sct:768839008 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "768839008" ] ;
fhir:display [ fhir:v "Consultant" ]         ] )       ] ;
      ( fhir:benefit [
fhir:type [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "benefit" ] ;
fhir:display [ fhir:v "Benefit" ]           ] )         ] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "50000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ]         ] ;
fhir:used [
a fhir:Money ;
fhir:value [ fhir:v "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ]         ]       ] )     ] [
fhir:productOrService [
        ( fhir:coding [
a sct:765507008 ;
fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
fhir:code [ fhir:v "765507008" ] ;
fhir:display [ fhir:v "Metformin hydrochloride 500 mg prolonged-release oral tablet" ]         ] )       ] ;
      ( fhir:benefit [
fhir:type [
          ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/benefit-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "benefit" ] ;
fhir:display [ fhir:v "Benefit" ]           ] )         ] ;
fhir:allowed [
a fhir:Money ;
fhir:value [ fhir:v "50000"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ]         ] ;
fhir:used [
a fhir:Money ;
fhir:value [ fhir:v "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "INR" ]         ]       ] )     ] )
  ] ) . #