Resource StructureDefinition/FHIR Server from package jp-core.r4#1.1.1-rc (94 ms)
Resources that use this resource
Resources that this resource uses
Source
{
"resourceType" : "StructureDefinition",
"id" : "jp-coverage",
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-category",
"valueString" : "Financial.Support"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-security-category",
"valueCode" : "patient"
}
],
"url" : "http://jpfhir.jp/fhir/core/StructureDefinition/JP_Coverage",
"version" : "1.1.1",
"name" : "JP_Coverage",
"title" : "JP Core Coverage Profile",
"status" : "active",
"date" : "2022-10-24",
"description" : "ãã®ãããã¡ã¤ã«ã¯Coverageãªã½ã¼ã¹ã«å¯¾ãã¦ãä¿éºã»å
¬è²»ã®ãã¼ã¿ãéåä¿¡ããããã®åºç¤ã¨ãªãå¶ç´ã¨æ¡å¼µãå®ãããã®ã§ããã",
"fhirVersion" : "4.0.1",
"mapping" : [
{
"identity" : "workflow",
"uri" : "http://hl7.org/fhir/workflow",
"name" : "Workflow Pattern"
},
{
"identity" : "rim",
"uri" : "http://hl7.org/v3",
"name" : "RIM Mapping"
},
{
"identity" : "w5",
"uri" : "http://hl7.org/fhir/fivews",
"name" : "FiveWs Pattern Mapping"
},
{
"identity" : "cdanetv4",
"uri" : "http://www.cda-adc.ca/en/services/cdanet/",
"name" : "Canadian Dental Association eclaims standard"
},
{
"identity" : "v2",
"uri" : "http://hl7.org/v2",
"name" : "HL7 v2 Mapping"
},
{
"identity" : "cpha3pharm",
"uri" : "http://www.pharmacists.ca/",
"name" : "Canadian Pharmacy Associaiton eclaims standard"
}
],
"kind" : "resource",
"abstract" : false,
"type" : "Coverage",
"baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Coverage",
"derivation" : "constraint",
"differential" : {
"element" : [
{
"id" : "Coverage",
"path" : "Coverage",
"short" : "Insurance or medical plan or a payment agreementãä¿éºã¾ãã¯å»çè²»æ¯æããã©ã³ãã¾ãã¯åæãããæ¯æãæ¹æ³",
"definition" : "Financial instrument which may be used to reimburse or pay for health care products and services. Includes both insurance and self-payment.\r\n\r\nãã«ã¹ã±ã¢è£½åããã³ãµã¼ãã¹ã®åéã¾ãã¯æ¯æãã«ä½¿ç¨ãããå¯è½æ§ã®ããéèååã ä¿éºã¨èªå·±è² æ
ã®ä¸¡æ¹ãå«ã¾ããã",
"comment" : "The Coverage resource contains the insurance card level information, which is customary to provide on claims and other communications between providers and insurers.\r\n\r\nCoverageã«ã¯ãä¿éºè¨¼ã¬ãã«ã®æ
å ±ãå«ã¾ãã¦ãããããã¯ãä¿éºéè«æ±ããããã¤ãã¨ä¿éºä¼ç¤¾éã®ãã®ä»ã®éä¿¡ã§æä¾ããã®ãéä¾ã§ããã"
},
{
"id" : "Coverage.extension",
"path" : "Coverage.extension",
"slicing" : {
"discriminator" : [
{
"type" : "value",
"path" : "url"
}
],
"rules" : "open"
}
},
{
"id" : "Coverage.extension:insuredPersonSymbol",
"path" : "Coverage.extension",
"sliceName" : "insuredPersonSymbol",
"min" : 0,
"max" : "*",
"type" : [
{
"code" : "Extension",
"profile" : [
"http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSymbol"
]
}
]
},
{
"id" : "Coverage.extension:insuredPersonNumber",
"path" : "Coverage.extension",
"sliceName" : "insuredPersonNumber",
"min" : 0,
"max" : "*",
"type" : [
{
"code" : "Extension",
"profile" : [
"http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonNumber"
]
}
]
},
{
"id" : "Coverage.extension:insuredPersonSubNumber",
"path" : "Coverage.extension",
"sliceName" : "insuredPersonSubNumber",
"min" : 0,
"max" : "*",
"type" : [
{
"code" : "Extension",
"profile" : [
"http://jpfhir.jp/fhir/core/Extension/StructureDefinition/JP_Coverage_InsuredPersonSubNumber"
]
}
]
},
{
"id" : "Coverage.identifier",
"path" : "Coverage.identifier",
"short" : "Business Identifier for the coverageããã®ã«ãã¬ãã¸ã«å²ãå½ã¦ãããä¸æã®èå¥åãã詳細åç
§ã",
"definition" : "A unique identifier assigned to this coverage.\r\n\r\nãã®ã«ãã¬ãã¸ã«å²ãå½ã¦ãããä¸æã®èå¥åã",
"comment" : "The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependent.\r\n\r\nã«ãã¬ãã¸ã®ã¡ã¤ã³ï¼ããã³å ´åã«ãã£ã¦ã¯å¯ä¸ã®ï¼èå¥å-å¤ãã®å ´åãã¡ã³ãIDã証ææ¸çªå·ãå人ã®å¥åº·çªå·ãã¾ãã¯ã±ã¼ã¹IDã¨å¼ã°ããã\r\n\r\nãJP Coreä»æ§ã被ä¿éºè
è¨å·ã¨çªå·ã¨æçªãå
¨è§ã«ããä¸ã§ããã«ã³ã¼ãã¼ã·ã§ã³ã§å²ããã«ã³ãåºåãã§é£çµããã\r\n\r\nã«ã¼ã«ï¼\"{被ä¿éºè
è¨å·}\",\"{被ä¿éºè
çªå·}\",\"{æçª}\"\r\n\r\nä¾ï¼\"ï¼ï¼ï¼ï¼ï¼\",\"ï¼ï¼ï¼ï¼\",\"ï¼ï¼\"",
"requirements" : "Allows coverages to be distinguished and referenced.\r\n\r\nã«ãã¬ãã¸ãåºå¥ãã¦åç
§ã§ããããã«ããã"
},
{
"id" : "Coverage.status",
"path" : "Coverage.status",
"definition" : "The status of the resource instance.\r\n\r\nãªã½ã¼ã¹ã¤ã³ã¹ã¿ã³ã¹ã®ã¹ãã¼ã¿ã¹ã",
"comment" : "This element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.\r\n\r\nã¹ãã¼ã¿ã¹ã«ã¯ãã«ãã¬ãã¸ãç¾å¨ç¡å¹ã§ãããã¨ã示ãã¨ã©ã¼å
¥åãããã³ã¼ããå«ã¾ãã¦ããããããã®è¦ç´ ã¯ä¿®é£¾åã¨ãã¦ã©ãã«ä»ããããã",
"requirements" : "Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.\r\n\r\nããã©ããããªã½ã¼ã¹ã¯ããã«ç·¨éãããå¯è½æ§ãããããã¢ã¯ãã£ãããªã½ã¼ã¹ã¯ä¸å¤ã§ãããã¹ãã¼ã¿ã¹ãããã£ã³ã»ã«ãã«å¤æ´ãããã ãã§ããå¯è½æ§ãããããããªã½ã¼ã¹ã®ã¹ãã¼ã¿ã¹ã追跡ããå¿
è¦ãããã",
"isModifierReason" : "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid / ãã®è¦ç´ ã¯ãã¨ã©ã¼ã§å
¥åãããã¹ãã¼ã¿ã¹ãå«ãã¹ãã¼ã¿ã¹è¦ç´ ã§ããããã修飾åã¨ãã¦ã©ãã«ä»ãããã¦ãããããã¯ããªã½ã¼ã¹ãæå¹ã¨ãã¦æ±ãããã¹ãã§ã¯ãªããã¨ãæå³ããã"
},
{
"id" : "Coverage.type",
"path" : "Coverage.type",
"short" : "Coverage category such as medical or accidentãå»çä¿éºãäºæ
è£åã®ãããªåé¡",
"definition" : "The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health or payment by an individual or organization.\r\n\r\nè£åã®ç¨®é¡ï¼ç¤¾ä¼ããã°ã©ã ãå»çè¨ç»ãäºæ
è£åï¼å´åè
ç½å®³è£åãèªåè»ï¼ãã°ã«ã¼ãã®å¥åº·ãã¾ãã¯å人ã¾ãã¯çµç¹ã«ããæ¯æãã",
"comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.\r\n\r\nãã¹ã¦ã®ã¿ã¼ãããã¸ã®ä½¿ç¨ããã®ä¸è¬çãªãã¿ã¼ã³ã«é©åããããã§ã¯ãªããå ´åã«ãã£ã¦ã¯ãã¢ãã«ã¯CodeableConceptã使ç¨ãããã³ã¼ãã£ã³ã°ãç´æ¥ä½¿ç¨ãã¦ãããã¹ããã³ã¼ãã£ã³ã°ã翻訳ãããã³è¦ç´ éã®é¢ä¿ã¨pre-coordinationã¨post-coordinationã®ç¨èªé¢ä¿ã管çããããã®ç¬èªã®æ§é ãæä¾ããå¿
è¦ãããã\n\r\n\r\nãJP Coreä»æ§ãã[å¦æ¹æ
å ± HL7FHIR è¨è¿°ä»æ§](https://std.jpfhir.jp/stddoc/ePrescriptionDataFHIR_v1x.pdf)ãçã§ä½¿ç¨ãããä¿éºç¨®å¥ã³ã¼ãï¼system=âurn:oid:1.2.392.100495.20.2.61âï¼ã¨ãã¦ãhttps://www.mhlw.go.jp/content/10800000/000342368.pdfãã®å¥è¡¨ï¼ï¼ã使ç¨ãã¦ããä¾ãããããã¦ãããJP Coreã¨ãã¦æ¬é
ç®ã«å¯¾ããç¨èªã®ãã¤ã³ãã¯ç¾æç¹ã§ã¯å®ç¾©ããã¾ã§ã«è³ã£ã¦ããªãã",
"requirements" : "The order of application of coverages is dependent on the types of coverage.\r\n\r\nã«ãã¬ãã¸ã®é©ç¨é åºã¯ãã«ãã¬ãã¸ã®ã¿ã¤ãã«ãã£ã¦ç°ãªãã"
},
{
"id" : "Coverage.policyHolder",
"path" : "Coverage.policyHolder",
"short" : "Owner of the policyãããªã·ã®ææè
",
"definition" : "The party who 'owns' the insurance policy.\r\n\r\nä¿éºè¨¼å¸ããææãããå½äºè
ã",
"comment" : "For example: may be an individual, corporation or the subscriber's employer.\r\n\r\nä¾ï¼å人ãä¼æ¥ãã¾ãã¯å å
¥è
ã®éç¨ä¸»ã§ããå¯è½æ§ãããã",
"requirements" : "This provides employer information in the case of Worker's Compensation and other policies.\r\n\r\nããã¯ãå´åè
ç½å®³è£åããã³ãã®ä»ã®ããªã·ã®å ´åã«éç¨è
æ
å ±ãæä¾ããã",
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://jpfhir.jp/fhir/core/StructureDefinition/JP_Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson",
"http://jpfhir.jp/fhir/core/StructureDefinition/JP_Organization"
]
}
]
},
{
"id" : "Coverage.subscriber",
"path" : "Coverage.subscriber",
"short" : "Subscriber to the policyã被ä¿éºè
",
"definition" : "The party who has signed-up for or 'owns' the contractual relationship to the policy or to whom the benefit of the policy for services rendered to them or their family is due.\r\n\r\nããªã·ã«ãµã¤ã³ã¢ãããããã¾ãã¯ããªã·ã¨ã®å¥ç´é¢ä¿ããææããã¦ããå½äºè
ãã¾ãã¯ããªã·ã®å©çãå½¼ãã¾ãã¯ãã®å®¶æã«æä¾ããããã¨ã«ãªã£ã¦ããå½äºè
ã",
"comment" : "May be self or a parent in the case of dependents.\r\n\r\næ¶é¤å®¶æã®å ´åãèªå·±ã¾ãã¯è¦ªã§ããå¯è½æ§ãããã",
"requirements" : "This is the party who is entitled to the benefits under the policy.\r\n\r\nããã¯ãããªã·ã«åºã¥ãã¦çµ¦ä»ãåãã権å©ãæããå½äºè
ã§ããã",
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://jpfhir.jp/fhir/core/StructureDefinition/JP_Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
]
},
{
"id" : "Coverage.subscriberId",
"path" : "Coverage.subscriberId",
"short" : "ID assigned to the subscriberã被ä¿éºè
ã«å²ãå½ã¦ãããID",
"definition" : "The insurer assigned ID for the Subscriber.\r\n\r\n被ä¿éºè
ã«ä¿éºè
ãå²ãå½ã¦ãID",
"requirements" : "The insurer requires this identifier on correspondence and claims (digital and otherwise).\r\n\r\nä¿éºè
ã¯ãé£çµ¡ãè«æ±ï¼ãã¸ã¿ã«ããã³ãã®ä»ï¼ã§ãã®èå¥åãè¦æ±ããã\r\nä¿éºä¼ç¤¾ã¯ãéä¿¡ããã³è«æ±ï¼ãã¸ã¿ã«ããã³ãã®ä»ï¼ã§ãã®èå¥åãè¦æ±ããã\r\n\r\nãJP Coreä»æ§ã被ä¿éºè
è¨å·ã¨çªå·ãå
¨è§ã«ããä¸ã§ããã«ã³ã¼ãã¼ã·ã§ã³ã§å²ããã«ã³ãåºåãã§é£çµããã\r\n\r\nã«ã¼ã«ï¼\"{被ä¿éºè
è¨å·}\",\"{被ä¿éºè
çªå·}\"\r\n\r\nä¾ï¼\"ï¼ï¼ï¼ï¼ï¼\",\"ï¼ï¼ï¼ï¼\""
},
{
"id" : "Coverage.beneficiary",
"path" : "Coverage.beneficiary",
"definition" : "The party who benefits from the insurance coverage; the patient when products and/or services are provided.\r\n\r\nä¿éºé©ç¨ããå©çãå¾ãå½äºè
ã製åããã³ï¼ã¾ãã¯ãµã¼ãã¹ãæä¾ãããéã®æ£è
ã",
"comment" : "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.\r\n\r\nåç
§ã¯ãå®éã®FHIRãªã½ã¼ã¹ã¸ã®åç
§ã§ããå¿
è¦ãããã解決å¯è½ï¼å
容ã«å°éå¯è½ï¼ã§ããå¿
è¦ãããï¼ã¢ã¯ã»ã¹å¶å¾¡ãä¸æçãªä½¿ç¨ä¸å¯ãªã©ãèæ
®ã«å
¥ããï¼ã解決ã¯ãURLããåå¾ãããããªã½ã¼ã¹ã¿ã¤ãã«ãã£ã¦è©²å½ããå ´åã¯ã絶対åç
§ãæ£è¦URLã¨ãã¦æ±ãããã¼ã«ã«ã¬ã¸ã¹ããª/ãªãã¸ããªã§æ¤ç´¢ãããã¨ã«ãã£ã¦è¡ããã¨ãã§ããã\r\n\r\nãJP Coreä»æ§ãæ£è
Patientãªã½ã¼ã¹ã¸ã®åç
§ã",
"requirements" : "This is the party who receives treatment for which the costs are reimbursed under the coverage.\r\n\r\nããã¯ãè£åã®ä¸ã§è²»ç¨ãåéãããæ²»çãåããå´ã®ãã¨ã§ããã",
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://jpfhir.jp/fhir/core/StructureDefinition/JP_Patient"
]
}
]
},
{
"id" : "Coverage.dependent",
"path" : "Coverage.dependent",
"short" : "被ä¿éºè
証 æçª",
"definition" : "A unique identifier for a dependent under the coverage.\r\n\r\n被ä¿éºè
証ã®æçªã",
"comment" : "Periodically the member number is constructed from the subscriberId and the dependent number.\r\n\r\n被ä¿éºè
証ã®æçªãå
¨è§ã§æ ¼ç´ããã",
"requirements" : "For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.\r\n\r\nä¸é¨ã®è£åã§ã¯ãåä¸ã®èå¥åãå å
¥è
ã«çºè¡ããã次ã«ä¸æã®å¾å±çªå·ãååçè
ã«çºè¡ãããã\r\nä¸é¨ã®ä¿éºã§ã¯ãåä¸ã®èå¥åãå å
¥è
ã«çºè¡ããããã®å¾ãååçè
ã«åºæã®æ¶é¤çªå·ãçºè¡ãããã\r\n\r\nãJP Coreä»æ§ãå»çä¿éºã§æ¬ãªã½ã¼ã¹ã使ç¨ããå ´åã«ã¯ããã®è¦ç´ ã«æ¡å¼µ InsuredPersonSubNumberã«è¨å®ããå¤ã¨åãã被ä¿éºè
çªå·ã®æçªå·å
¨è§2æ¡ãè¨å®ããã\r\n\r\nä¾ï¼\"ï¼ï¼\""
},
{
"id" : "Coverage.relationship",
"path" : "Coverage.relationship",
"short" : "Beneficiary relationship to the subscriberãå å
¥è
ã¨ã®åçè
é¢ä¿",
"definition" : "The relationship of beneficiary (patient) to the subscriber.\r\n\r\nåçè
ï¼æ£è
ï¼ã¨å å
¥è
ã®é¢ä¿ã",
"comment" : "Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.\r\n\r\nä¸è¬çã«ãå人ã¯ãä»äººãææããããªã·ããããèªåã®ããªã·ï¼relationship='self'ï¼ã使ç¨ããã",
"requirements" : "To determine relationship between the patient and the subscriber to determine coordination of benefits.\r\n\r\næ£è
ã¨å å
¥è
ã®é¢ä¿ã決å®ãã給ä»ã®èª¿æ´ã決å®ããã\r\n\r\nãJP Coreä»æ§ãã[å¦æ¹æ
å ± HL7FHIR è¨è¿°ä»æ§](https://std.jpfhir.jp/stddoc/ePrescriptionDataFHIR_v1x.pdf)ãçã§ä½¿ç¨ããã被ä¿éºè
åºåã³ã¼ãï¼system=âurn:oid:1.2.392.100495.20.2.62âï¼ã¨ãã¦ãhttps://www.mhlw.go.jp/content/10800000/000342368.pdfãã®å¥è¡¨ï¼ï¼ã使ç¨ã§ããã\r\n1ã被ä¿éºè
\r\n2ã被æ¶é¤è
"
},
{
"id" : "Coverage.period",
"path" : "Coverage.period",
"definition" : "Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force.\r\n\r\nè£åç¯å²ãæå¹ã§ããæéãéå§æ¥ãæ¬ è½ãã¦ããå ´åã¯ãéå§æ¥ãä¸æã§ãããã¨ã示ããçµäºæ¥ãæ¬ è½ãã¦ããå ´åã¯ãè£åç¯å²ãå¼ãç¶ãæå¹ã§ãããã¨ãæå³ããã",
"comment" : "A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\").\nPeriod is not used for a duration (a measure of elapsed time). See [Duration](http://hl7.org/fhir/R4/datatypes.html#Duration).\r\n\r\nPeriodï¼æéï¼ã¯æéã®ç¯å²ãæå®ããã使ç¨ç¶æ³ã¯ãç¯å²å
¨ä½ãé©ç¨ããããï¼ãã¨ãã°ããæ£è
ã¯ãã®æéç¯å²ã§å
¥é¢ãã¦ãããï¼ãç¯å²ãã1ã¤ã®å¤ãé©ç¨ããããï¼ãã¨ãã°ãããã®2åã®éã«æ£è
ã«æä¸ãããï¼ãæå®ããã\r\nPeriodï¼æéï¼ã¯ãDurationï¼æéåºéï¼çµéæéã®æ¸¬å®å¤ï¼ã«ã¯ä½¿ç¨ãããªãã [Duration]ï¼datatypes.htmlï¼Durationï¼ãåç
§ã®ãã¨ã\r\nThis is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\"). If duration is required, specify the type as Interval|Duration.\r\n\r\nããã¯Durationï¼æéåºéï¼ã§ã¯ãªã-ãDurationã¯æéã®å°ºåº¦ï¼å¥ã®ã¿ã¤ãï¼ã ããæéã®åºå®å¤ã§çºçããæéåºéã§ãããPeriodï¼æéï¼ã¯æéã®ç¯å²ãæå®ããã使ç¨ç¶æ³ã¯ãç¯å²å
¨ä½ãé©ç¨ããããï¼ãã¨ãã°ããæ£è
ã¯ãã®æéç¯å²ã§å
¥é¢ãã¦ãããï¼ãç¯å²ãã1ã¤ã®å¤ãé©ç¨ããããï¼ãã¨ãã°ãããã®2åã®éã«æ£è
ã«æä¸ãããï¼ãæå®ããããããDurationï¼æéåºéï¼ãå¿
è¦ãªå ´åã¯ãã¿ã¤ããInterval | Durationã¨ãã¦æå®ããã\r\nããã¯æéã§ã¯ãªã-ããã¯æéã®å°ºåº¦ï¼å¥ã®ã¿ã¤ãï¼ããããæéã®åºå®å¤ã§çºçããæéã§ãããæéã¯æéã®ç¯å²ãæå®ããã使ç¨ç¶æ³ã¯ãç¯å²å
¨ä½ãé©ç¨ããããï¼ãã¨ãã°ããæ£è
ã¯ãã®æéç¯å²ã§å
¥é¢ãã¦ãããï¼ãã¾ãã¯ç¯å²ãã1ã¤ã®å¤ãé©ç¨ããããï¼ãã¨ãã°ããããã2åã®éã«æ£è
ã«ä¸ãããï¼ãæå®ãããæéãå¿
è¦ãªå ´åã¯ãã¿ã¤ããInterval | Durationã¨ãã¦æå®ããã\r\n\r\nãJP Coreä»æ§ãå»çä¿éºãå
¬è²»ã§æ¬ãªã½ã¼ã¹ã使ç¨ããå ´åã«ã¯ãä¿éºè¨¼ã¾ãã¯å
¬è²»ã®æå¹æéã®éå§æ¥ãçµäºæ¥ãstart ã¨endã« yyyy-mm-ddå½¢å¼ã§è¨å®ããã",
"requirements" : "Some insurers require the submission of the coverage term.\r\n\r\nä¿éºä¼ç¤¾ã«ãã£ã¦ã¯ãè£åæéã®æåºã義åä»ãã¦ããã¨ãããããã"
},
{
"id" : "Coverage.payor",
"path" : "Coverage.payor",
"definition" : "The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.\r\n\r\næ£è
è² æ
å¥ç´ãªã©ã®ä¿éºå¥ç´ã¨ä¿éºå¤å¥ç´ã®ä¸¡æ¹ãå«ãããã°ã©ã ã¾ãã¯ãã©ã³ã®å¼å人ã¾ãã¯æ¯æ人ã",
"comment" : "May provide multiple identifiers such as insurance company identifier or business identifier (BIN number).\nFor selfpay it may provide multiple paying persons and/or organizations.\r\n\r\nä¿éºä¼ç¤¾ã®èå¥åãäºæ¥è
ã®èå¥åï¼BINçªå·ï¼ãªã©ãè¤æ°ã®èå¥åãæä¾ãã¦ããããèªå·±è² æ
ã®å ´åã¯ãè¤æ°ã®æ¯æè
ããã³/ã¾ãã¯çµç¹ãæä¾ãã¦ãããã",
"requirements" : "Need to identify the issuer to target for claim processing and for coordination of benefit processing.\r\n\r\nè«æ±å¦çããã³çµ¦ä»å¦çã®èª¿æ´ã®å¯¾è±¡ã¨ãªãçºè¡è
ãç¹å®ããå¿
è¦ãããã\r\n\r\nãJP Coreä»æ§ãå»çä¿éºã§æ¬ãªã½ã¼ã¹ã使ç¨ããå ´åã«ã¯ãä¿éºè
çµç¹Organizationãªã½ã¼ã¹ã¸ã®åç
§ãèªè²»ã®å ´åã«ã¯ãæ£è
Patientãªã½ã¼ã¹ã¸ã®åç
§ãå
¬è²»ã®å ´åã«ã¯ãå
¬è²»è² æ
è
çµç¹Organizationãªã½ã¼ã¹ã¸ã®åç
§ã",
"type" : [
{
"code" : "Reference",
"targetProfile" : [
"http://jpfhir.jp/fhir/core/StructureDefinition/JP_Organization",
"http://jpfhir.jp/fhir/core/StructureDefinition/JP_Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
]
},
{
"id" : "Coverage.class",
"path" : "Coverage.class",
"definition" : "A suite of underwriter specific classifiers.\r\n\r\nä¿éºäºæ¥è
ã®åé¡å",
"comment" : "For example may be used to identify a class of coverage or employer group, Policy, Plan.\r\n\r\nä¾ãã°ãä¿éºã®ç¨®é¡ã¾ãã¯éç¨è
ã°ã«ã¼ããä¿éºå¥ç´ãPlanãèå¥ããããã«ä½¿ç¨ãããã¨ãã§ããã",
"requirements" : "The codes provided on the health card which identify or confirm the specific policy for the insurer.\r\n\r\nå¥åº·ã«ã¼ãã«è¨è¼ããã¦ããã³ã¼ãã§ãä¿éºè
ã®ç¹å®ã®ä¿éºå¥ç´ãèå¥ã¾ãã¯ç¢ºèªãããã®ã"
},
{
"id" : "Coverage.class.type",
"path" : "Coverage.class.type",
"definition" : "The type of classification for which an insurer-specific class label or number and optional name is provided, for example may be used to identify a class of coverage or employer group, Policy, Plan.\r\n\r\nä¿éºè
åºæã®ã¯ã©ã¹ã©ãã«ã¾ãã¯çªå·ãä»»æã®ååãæä¾ããã¦ããåé¡ã®ã¿ã¤ãã表ããä¾ãã°ãä¿éºã®ã¯ã©ã¹ã¾ãã¯éç¨è
ã°ã«ã¼ããä¿éºå¥ç´ãPlanãèå¥ããããã«ä½¿ç¨ãããã¨ãã§ããã",
"comment" : "Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.\r\n\r\nãã¹ã¦ã®ç¨èªã®ä½¿ç¨ããã®ä¸è¬çãªãã¿ã¼ã³ã«é©åããããã§ã¯ãªããããã¤ãã®ã±ã¼ã¹ã§ã¯ãã¢ãã«ã¯CodeableConceptã使ç¨ãããCodingãç´æ¥ä½¿ç¨ããããã¹ããã³ã¼ãã£ã³ã°ã翻訳ãè¦ç´ éã®é¢ä¿ãããã³åå¾ã®èª¿æ´ã管çããããã®ç¬èªã®æ§é ãæä¾ãããã¨ãæã¾ããã",
"requirements" : "The insurer issued label for a specific health card value.\r\n\r\nä¿éºè
ãçºè¡ããç¹å®ã®å¥åº·ã«ã¼ãçªå·ã®ã©ãã«ã"
},
{
"id" : "Coverage.class.value",
"path" : "Coverage.class.value",
"definition" : "The alphanumeric string value associated with the insurer issued label.\r\n\r\nä¿éºè
ãçºè¡ããã©ãã«ã«é¢é£ä»ããããè±æ°åã®æååå¤ã",
"comment" : "For example, the Group or Plan number.\r\n\r\nä¾ãã°ãã°ã«ã¼ãçªå·ããã©ã³çªå·ãªã©ã",
"requirements" : "The insurer issued label and value are necessary to identify the specific policy.\r\n\r\nä¿éºè
ãçºè¡ããã©ãã«ã¨å¤ã¯ãç¹å®ã®ä¿éºå¥ç´ãèå¥ããããã«å¿
è¦ãªãã®ã§ããã"
},
{
"id" : "Coverage.class.name",
"path" : "Coverage.class.name",
"definition" : "A short description for the class.\r\n\r\nä¿éºç¨®é¡ã®ç°¡åãªèª¬æã",
"requirements" : "Used to provide a meaningful description in correspondence to the patient.\r\n\r\næ£è
ã«å¯¾å¿ããã®ã«æå³ã®ãã説æãããããã«ä½¿ç¨ããã"
},
{
"id" : "Coverage.order",
"path" : "Coverage.order",
"definition" : "The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care.\r\n\r\nç¾å¨é©ç¨ããã¦ããä»ã®ä¿éã¨æ¯è¼ãã¦ããã®ä¿éã®é©ç¨å¯è½æ§ãé«ãé ã«è¨è¼ããã¦ããããªãããã³ããªã³ã°ã«ã®ã£ãããããå ´åããããã«ãã¼ã®å
·ä½çãªä½ç½®ã¥ãã¯ã±ã¢ã®ã¨ãã½ã¼ãã«ä¾åãããããä¸æ¬¡ãäºæ¬¡ãªã©ãæå³ãããã®ã§ã¯ãªãã",
"comment" : "32 bit number; for values larger than this, use decimal\r\n\r\n32 ãããã®æ°å¤ããããã大ããå¤ã®å ´å㯠10 é²æ°ã使ç¨ããã",
"requirements" : "Used in managing the coordination of benefits.\r\n\r\nä¿éºçµ¦ä»ã®èª¿æ´ç®¡çã«ä½¿ç¨ããã\r\n\r\nãJP Coreä»æ§ãå
¬è²»æ
å ±ã§æ¬ãªã½ã¼ã¹ã使ç¨ããå ´åã§ãè¤æ°ã®å
¬è²»è² æ
æ
å ±ãããå ´åã«ããã®é©ç¨é åºçªå·ã示ãï¼ï¼ï¼ï¼ï¼ï¼ï¼ï¼ãè¨å®ããã"
},
{
"id" : "Coverage.network",
"path" : "Coverage.network",
"definition" : "The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.\r\n\r\nä¿éºè
ãå®ç¾©ãããããã¤ãã®ä¿éºè
å®ç¾©ãããã¯ã¼ã¯ã®ä¿éºè
åºæã®èå¥åã§ã被ä¿éºè
ãããããã¯ã¼ã¯å
ãã®æéã§ã«ãã¼ãããæ²»çãåãããã¨ãã§ããããããã§ãªããã°ããããã¯ã¼ã¯å¤ãã®æ¡ä»¶ãé©ç¨ãããã",
"requirements" : "Used in referral for treatment and in claims processing.\r\n\r\næ²»çã®ããã®ç´¹ä»ãè«æ±å¦çã®éã«ä½¿ç¨ããã"
},
{
"id" : "Coverage.costToBeneficiary",
"path" : "Coverage.costToBeneficiary",
"short" : "Patient payments for services/productsããµã¼ãã¹ããããã¯ãã«å¯¾ããæ£è
æ¯æã",
"definition" : "A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.\r\n\r\nããªã·ã«è©³ç´°ãè¨è¼ããã¦ããããã«ã¹ã«ã¼ãã«å«ã¾ãã¦ããå¯è½æ§ã®ããã³ã¹ãã«ãã´ãªã¨é¢é£ããéé¡ã示ãä¸é£ã®ã³ã¼ãã",
"comment" : "For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.\r\n\r\nä¾ãã°ãæ£è
ã®è¨ªåæã®èªå·±è² æ
é¡ãç¥ããã¨ã§ãå»çæä¾è
ã¯æ²»çãè¡ãåã«ãã®éé¡ãååãããã¨ãã§ããã\r\n\r\nãJP Coreä»æ§ãå
¬è²»ã®å ´åã«ã¯èªå·±è² æ
çãå¤æãã¦ããå ´åã®ã¿è¨å®ããã",
"requirements" : "Required by providers to manage financial transaction with the patient.\r\n\r\näºæ¥è
ãæ£è
ã¨ã®ééçãªåå¼ã管çããããã«å¿
è¦ã¨ãªãã"
},
{
"id" : "Coverage.costToBeneficiary.type",
"path" : "Coverage.costToBeneficiary.type",
"definition" : "The category of patient centric costs associated with treatment.\r\n\r\næ²»çã«ä¼´ãæ£è
ä¸å¿ã®è²»ç¨ã®ã«ãã´ãªã¼ã",
"comment" : "For example visit, specialist visits, emergency, inpatient care, etc.\r\n\r\nä¾ãã°ã訪å診çãå°éå»ã®è¨ªå診çãææ¥è¨ºçãå
¥é¢è¨ºçãªã©ã",
"requirements" : "Needed to identify the category associated with the amount for the patient.\r\n\r\næ£è
ã®éé¡ã«é¢é£ããã«ãã´ãªã¼ãç¹å®ããå¿
è¦ãããã¾ããã"
},
{
"id" : "Coverage.costToBeneficiary.type.coding.system",
"path" : "Coverage.costToBeneficiary.type.coding.system",
"comment" : "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.\r\n\r\nä¿éºãå
¬è²»ã«ãããèªå·±è² æ
çã®ç¨®å¥ãèå¥ããã³ã¼ãä½ç³»ã®ã³ã¼ãã\r\n\"http://terminology.hl7.org/CodeSystem/coverage-copay-type\""
},
{
"id" : "Coverage.costToBeneficiary.type.coding.code",
"path" : "Coverage.costToBeneficiary.type.coding.code",
"comment" : "Note that FHIR strings SHALL NOT exceed 1MB in size\r\n\r\nèªå·±è² æ
çã表ãã³ã¼ãã\"copaypct\""
},
{
"id" : "Coverage.costToBeneficiary.value[x]",
"path" : "Coverage.costToBeneficiary.value[x]",
"definition" : "The amount due from the patient for the cost category.\r\n\r\nè²»ç¨åºåã®æ£è
ããã®æ¯æé¡ã",
"comment" : "Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.\r\n\r\néé¡ã¯ããµã¼ãã¹/製åã®ã³ã¹ãã«å¯¾ããå²åã§è¡¨ç¾ãããå ´åã¨ãé貨ã®åºå®é¡ã§è¡¨ç¾ãããå ´åãããã",
"requirements" : "Needed to identify the amount for the patient associated with the category.\r\n\r\nã«ãã´ãªã¼ã«é¢é£ããæ£è
ã®æ¯æãéé¡ãç¹å®ããå¿
è¦ãããã¾ããã"
},
{
"id" : "Coverage.costToBeneficiary.exception",
"path" : "Coverage.costToBeneficiary.exception",
"definition" : "A suite of codes indicating exceptions or reductions to patient costs and their effective periods.\r\n\r\næ£è
è²»ç¨ã®ä¾å¤ã¾ãã¯åæ¸ã示ãã³ã¼ãã¨ãã®æå¹æéã示ãã³ã¼ã群ã",
"requirements" : "Required by providers to manage financial transaction with the patient.\r\n\r\näºæ¥è
ãæ£è
ã¨ã®ééçãªåå¼ã管çããããã«å¿
è¦ã¨ãªãã"
},
{
"id" : "Coverage.costToBeneficiary.exception.type",
"path" : "Coverage.costToBeneficiary.exception.type",
"definition" : "The code for the specific exception.\r\n\r\nç¹å®ã®ä¾å¤ã®ã³ã¼ãã",
"requirements" : "Needed to identify the exception associated with the amount for the patient.\r\n\r\næ£è
ã®éé¡ã«é¢é£ããä¾å¤ãç¹å®ããå¿
è¦ããã£ãã"
},
{
"id" : "Coverage.costToBeneficiary.exception.period",
"path" : "Coverage.costToBeneficiary.exception.period",
"definition" : "The timeframe during when the exception is in force.\r\n\r\nä¾å¤ãçºçãã¦ããéã®æéæ ã",
"requirements" : "Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.\r\n\r\næ£è
ã®è²»ç¨ãæ£ããè¨ç®ããããã®ä¾å¤ã®é©ç¨ææãç¹å®ããå¿
è¦ããã£ãã"
},
{
"id" : "Coverage.subrogation",
"path" : "Coverage.subrogation",
"short" : "Reimbursement to insurerãä¿éºè
ã¸ã®åé",
"definition" : "When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.\r\n\r\nsubrogation=trueã®å ´åããã®ä¿éºã¤ã³ã¹ã¿ã³ã¹ã¯è£å®ã®ããã§ã¯ãªããä¿éºè
ã«è²»ç¨ååã®ããã®è©³ç´°ãæä¾ããããã«å«ã¾ãã¦ããã (subrogation=代ä½ãsubrogation payment=代ä½ç´ä»)",
"comment" : "Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.\r\n\r\nä¸è¬çã«ãèªåè»ä¿éºãå´ç½ä¿éºã§ã¯ãå»çè²»æ¯æãè
ãäºæ
è«æ±ã«å¯¾ãã¦ååã§ããããã«ãsubrogationï¼true ã¨ãããã©ã°ãç«ã¦ããã¦ããã",
"requirements" : "See definition for when to be used.\r\n\r\n使ç¨ææã«ã¤ãã¦ã¯å®ç¾©ãåç
§ãããã¨ã"
},
{
"id" : "Coverage.contract",
"path" : "Coverage.contract",
"short" : "Contract detailsãå¥ç´ã®è©³ç´°",
"definition" : "The policy(s) which constitute this insurance coverage.\r\n\r\nãã®ä¿éºã®é©ç¨ç¯å²ãæ§æããããªã·ã",
"comment" : "References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.\r\n\r\nåç
§ã¯ãå®éã®FHIRãªã½ã¼ã¹ã¸ã®åç
§ã§ããå¿
è¦ãããã解決å¯è½ï¼å
容ã«å°éå¯è½ï¼ã§ããå¿
è¦ãããï¼ã¢ã¯ã»ã¹å¶å¾¡ãä¸æçãªä½¿ç¨ä¸å¯ãªã©ãèæ
®ã«å
¥ããï¼ã解決ã¯ãURLããåå¾ãããããªã½ã¼ã¹ã¿ã¤ãã«ãã£ã¦è©²å½ããå ´åã¯ã絶対åç
§ãæ£è¦URLã¨ãã¦æ±ãããã¼ã«ã«ã¬ã¸ã¹ããª/ãªãã¸ããªã§æ¤ç´¢ãããã¨ã«ãã£ã¦è¡ããã¨ãã§ããã",
"requirements" : "To reference the legally binding contract between the policy holder and the insurer.\r\n\r\nå¥ç´è
ã¨ä¿éºè
ã¨ã®éã®æ³çææåã®ããå¥ç´ãåç
§ããããã"
}
]
},
"text" : {
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.