FHIR IG Statistics: StructureDefinition/KBV_PR_AW_Krankenversicherungsverhaeltnis
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{
"resourceType": "StructureDefinition",
"url": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Krankenversicherungsverhaeltnis",
"version": "1.2.0",
"name": "KBV_PR_AW_Krankenversicherungsverhaeltnis",
"status": "active",
"publisher": "Kassenärztliche Bundesvereinigung (KBV)",
"copyright": "Copyright © [2020], Kassenärztliche Bundesvereinigung (KBV). All rights reserved.",
"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": "Versicherungsdaten",
"definition": "Kostenuebernahme im Rahmen eines Versicherungsverhaeltnisses in Deutschland"
},
{
"id": "Coverage.id",
"path": "Coverage.id",
"min": 1
},
{
"id": "Coverage.meta",
"path": "Coverage.meta",
"min": 1
},
{
"id": "Coverage.meta.versionId",
"path": "Coverage.meta.versionId",
"min": 1
},
{
"id": "Coverage.meta.lastUpdated",
"path": "Coverage.meta.lastUpdated",
"min": 1
},
{
"id": "Coverage.meta.profile",
"path": "Coverage.meta.profile",
"min": 1,
"max": "1",
"fixedCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Krankenversicherungsverhaeltnis|1.2.0"
},
{
"id": "Coverage.text",
"path": "Coverage.text",
"min": 1
},
{
"id": "Coverage.extension",
"path": "Coverage.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"rules": "open"
}
},
{
"id": "Coverage.extension:einlesedatumKarte",
"path": "Coverage.extension",
"sliceName": "einlesedatumKarte",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/einlesedatum-karte"
]
}
]
},
{
"id": "Coverage.extension:onlinepruefung",
"path": "Coverage.extension",
"sliceName": "onlinepruefung",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk"
]
}
]
},
{
"id": "Coverage.extension:versionEgk",
"path": "Coverage.extension",
"sliceName": "versionEgk",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/version-vsdm"
]
}
]
},
{
"id": "Coverage.extension:generationEgk",
"path": "Coverage.extension",
"sliceName": "generationEgk",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/generation-egk"
]
}
]
},
{
"id": "Coverage.extension:versichertenart",
"path": "Coverage.extension",
"sliceName": "versichertenart",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/versichertenart"
]
}
]
},
{
"id": "Coverage.extension:kostenerstattung",
"path": "Coverage.extension",
"sliceName": "kostenerstattung",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/kostenerstattung"
]
}
]
},
{
"id": "Coverage.extension:wop",
"path": "Coverage.extension",
"sliceName": "wop",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/wop"
]
}
]
},
{
"id": "Coverage.extension:besonderePersonengruppe",
"path": "Coverage.extension",
"sliceName": "besonderePersonengruppe",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/besondere-personengruppe"
]
}
]
},
{
"id": "Coverage.extension:dmpKennzeichen",
"path": "Coverage.extension",
"sliceName": "dmpKennzeichen",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen"
]
}
]
},
{
"id": "Coverage.extension:ruhenderLeistungsanspruch",
"path": "Coverage.extension",
"sliceName": "ruhenderLeistungsanspruch",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch"
]
}
]
},
{
"id": "Coverage.extension:zuzahlungsstatus",
"path": "Coverage.extension",
"sliceName": "zuzahlungsstatus",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus"
]
}
]
},
{
"id": "Coverage.extension:skt-Zusatzangabe",
"path": "Coverage.extension",
"sliceName": "skt-Zusatzangabe",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"https://fhir.kbv.de/StructureDefinition/KBV_EX_AW_SKT_Zusatzangabe"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.identifier",
"path": "Coverage.identifier",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "type.coding.code"
}
],
"rules": "open"
},
"short": "Primärer Identifier der Versicherung",
"definition": "Ein gesetzliches Versicherungsverhältnis sollte stets durch die eindeutige 30-stellige Versichertennummer identifiziert werden. Ist diese nicht bekannt, so wird die 10-stellige VersichertenID statt dessen verwendet.",
"comment": "TODO: Constraint, der prüft, dass mindestens entweder eine VersichertenID oder eine Krankenversichertennummer angegeben wurde.",
"max": "1",
"mustSupport": true
},
{
"id": "Coverage.identifier:KrankenversichertenID",
"path": "Coverage.identifier",
"sliceName": "KrankenversichertenID",
"max": "1",
"type": [
{
"code": "Identifier",
"profile": [
"http://fhir.de/StructureDefinition/identifier-kvid-10"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.identifier:KrankenversichertenID.type",
"path": "Coverage.identifier.type",
"min": 1
},
{
"id": "Coverage.identifier:KrankenversichertenID.period",
"path": "Coverage.identifier.period",
"max": "0"
},
{
"id": "Coverage.identifier:KrankenversichertenID.assigner",
"path": "Coverage.identifier.assigner",
"max": "0"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer",
"path": "Coverage.identifier",
"sliceName": "KVK-Versichertennummer",
"max": "1",
"mustSupport": true
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.use",
"path": "Coverage.identifier.use",
"max": "0"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type",
"path": "Coverage.identifier.type",
"min": 1
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type.coding",
"path": "Coverage.identifier.type.coding",
"min": 1,
"max": "1"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type.coding.system",
"path": "Coverage.identifier.type.coding.system",
"min": 1,
"fixedUri": "https://fhir.kbv.de/CodeSystem/KBV_CS_Base_identifier_type"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type.coding.version",
"path": "Coverage.identifier.type.coding.version",
"max": "0"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type.coding.code",
"path": "Coverage.identifier.type.coding.code",
"min": 1,
"fixedCode": "kvk"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type.coding.display",
"path": "Coverage.identifier.type.coding.display",
"max": "0"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type.coding.userSelected",
"path": "Coverage.identifier.type.coding.userSelected",
"max": "0"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.type.text",
"path": "Coverage.identifier.type.text",
"max": "0"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.system",
"path": "Coverage.identifier.system",
"min": 1,
"fixedUri": "http://fhir.de/NamingSystem/gkv/kvk-versichertennummer"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.value",
"path": "Coverage.identifier.value",
"min": 1
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.period",
"path": "Coverage.identifier.period",
"max": "0"
},
{
"id": "Coverage.identifier:KVK-Versichertennummer.assigner",
"path": "Coverage.identifier.assigner",
"max": "0"
},
{
"id": "Coverage.identifier:versichertennummer_pkv",
"path": "Coverage.identifier",
"sliceName": "versichertennummer_pkv",
"max": "1",
"type": [
{
"code": "Identifier",
"profile": [
"http://fhir.de/StructureDefinition/identifier-pkv"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.identifier:versichertennummer_pkv.type.text",
"path": "Coverage.identifier.type.text",
"max": "0"
},
{
"id": "Coverage.identifier:versichertennummer_pkv.period",
"path": "Coverage.identifier.period",
"max": "0"
},
{
"id": "Coverage.identifier:versichertennummer_pkv.assigner",
"path": "Coverage.identifier.assigner",
"type": [
{
"code": "Reference",
"targetProfile": [
"https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Organisation|1.2.0"
]
}
]
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer",
"path": "Coverage.identifier",
"sliceName": "pseudo-Krankenversichertennummer",
"max": "1"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type",
"path": "Coverage.identifier.type",
"min": 1
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type.coding",
"path": "Coverage.identifier.type.coding",
"min": 1,
"max": "1"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type.coding.system",
"path": "Coverage.identifier.type.coding.system",
"min": 1,
"fixedUri": "https://fhir.kbv.de/CodeSystem/KBV_CS_Base_identifier_type"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type.coding.version",
"path": "Coverage.identifier.type.coding.version",
"max": "0"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type.coding.code",
"path": "Coverage.identifier.type.coding.code",
"min": 1,
"fixedCode": "PseudoversichertenID"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type.coding.display",
"path": "Coverage.identifier.type.coding.display",
"max": "0"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type.coding.userSelected",
"path": "Coverage.identifier.type.coding.userSelected",
"max": "0"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.type.text",
"path": "Coverage.identifier.type.text",
"max": "0"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.system",
"path": "Coverage.identifier.system",
"min": 1,
"fixedUri": "http://fhir.de/NamingSystem/gkv/pseudo-kvid"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.value",
"path": "Coverage.identifier.value",
"min": 1
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.period",
"path": "Coverage.identifier.period",
"max": "0"
},
{
"id": "Coverage.identifier:pseudo-Krankenversichertennummer.assigner",
"path": "Coverage.identifier.assigner",
"max": "0"
},
{
"id": "Coverage.status",
"path": "Coverage.status",
"short": "active | cancelled",
"definition": "Der Status der Ressource darf nur active oder cancelled sein"
},
{
"id": "Coverage.type",
"path": "Coverage.type",
"short": "Versicherungsart",
"definition": "Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt",
"binding": {
"strength": "required",
"valueSet": "http://fhir.de/ValueSet/versicherungsart-de-basis"
}
},
{
"id": "Coverage.type.coding",
"path": "Coverage.type.coding",
"min": 1,
"max": "1"
},
{
"id": "Coverage.type.coding.system",
"path": "Coverage.type.coding.system",
"min": 1,
"fixedUri": "http://fhir.de/CodeSystem/versicherungsart-de-basis"
},
{
"id": "Coverage.type.coding.version",
"path": "Coverage.type.coding.version",
"min": 1
},
{
"id": "Coverage.type.coding.code",
"path": "Coverage.type.coding.code",
"min": 1
},
{
"id": "Coverage.type.coding.display",
"path": "Coverage.type.coding.display",
"max": "0"
},
{
"id": "Coverage.type.coding.userSelected",
"path": "Coverage.type.coding.userSelected",
"max": "0"
},
{
"id": "Coverage.type.text",
"path": "Coverage.type.text",
"max": "0"
},
{
"id": "Coverage.policyHolder",
"path": "Coverage.policyHolder",
"max": "0"
},
{
"id": "Coverage.subscriber",
"path": "Coverage.subscriber",
"short": "Hauptversicherte Person / Mitglied",
"definition": "Hauptversicherte Person (ggf. abweichend von beneficiary), z.B. bei Familienversicherung. Es muss entweder eine Referenz(mit den Attributen Haupterversichertenname und dessen ID) vorhanden sein oder die Attribute identifier und display müssen gefüllt sein.",
"type": [
{
"code": "Reference",
"targetProfile": [
"https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Patient|1.2.0",
"https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Bezugsperson|1.2.0"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.subscriber.type",
"path": "Coverage.subscriber.type",
"max": "0"
},
{
"id": "Coverage.subscriber.identifier",
"path": "Coverage.subscriber.identifier",
"short": "HauptversichertenID",
"definition": "Eine ID des Hauptversicherten",
"mustSupport": true
},
{
"id": "Coverage.subscriber.identifier.type",
"path": "Coverage.subscriber.identifier.type",
"min": 1
},
{
"id": "Coverage.subscriber.identifier.type.coding",
"path": "Coverage.subscriber.identifier.type.coding",
"min": 1,
"max": "1"
},
{
"id": "Coverage.subscriber.identifier.type.coding.system",
"path": "Coverage.subscriber.identifier.type.coding.system",
"min": 1,
"fixedUri": "https://fhir.kbv.de/CodeSystem/KBV_CS_AW_Krankenversicherung_ID_Typ"
},
{
"id": "Coverage.subscriber.identifier.type.coding.version",
"path": "Coverage.subscriber.identifier.type.coding.version",
"max": "0"
},
{
"id": "Coverage.subscriber.identifier.type.coding.code",
"path": "Coverage.subscriber.identifier.type.coding.code",
"min": 1,
"fixedCode": "HauptversichertenID"
},
{
"id": "Coverage.subscriber.identifier.type.coding.display",
"path": "Coverage.subscriber.identifier.type.coding.display",
"max": "0"
},
{
"id": "Coverage.subscriber.identifier.type.coding.userSelected",
"path": "Coverage.subscriber.identifier.type.coding.userSelected",
"max": "0"
},
{
"id": "Coverage.subscriber.identifier.type.text",
"path": "Coverage.subscriber.identifier.type.text",
"max": "0"
},
{
"id": "Coverage.subscriber.identifier.system",
"path": "Coverage.subscriber.identifier.system",
"min": 1
},
{
"id": "Coverage.subscriber.identifier.value",
"path": "Coverage.subscriber.identifier.value",
"short": "HauptversichertenID",
"definition": "VersichertenID des Hauptversicherten",
"min": 1
},
{
"id": "Coverage.subscriber.identifier.period",
"path": "Coverage.subscriber.identifier.period",
"max": "0"
},
{
"id": "Coverage.subscriber.identifier.assigner",
"path": "Coverage.subscriber.identifier.assigner",
"max": "0"
},
{
"id": "Coverage.subscriber.display",
"path": "Coverage.subscriber.display",
"short": "Hauptversichertenname",
"definition": "Anzugeben ist der Name des Hauptversicherten.",
"mustSupport": true
},
{
"id": "Coverage.subscriberId",
"path": "Coverage.subscriberId",
"max": "0"
},
{
"id": "Coverage.beneficiary",
"path": "Coverage.beneficiary",
"type": [
{
"code": "Reference",
"targetProfile": [
"https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Patient|1.2.0"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.beneficiary.reference",
"path": "Coverage.beneficiary.reference",
"min": 1
},
{
"id": "Coverage.beneficiary.type",
"path": "Coverage.beneficiary.type",
"max": "0"
},
{
"id": "Coverage.beneficiary.identifier",
"path": "Coverage.beneficiary.identifier",
"max": "0"
},
{
"id": "Coverage.beneficiary.display",
"path": "Coverage.beneficiary.display",
"max": "0"
},
{
"id": "Coverage.dependent",
"path": "Coverage.dependent",
"max": "0"
},
{
"id": "Coverage.relationship",
"path": "Coverage.relationship",
"max": "0"
},
{
"id": "Coverage.period",
"path": "Coverage.period",
"definition": "In diesem Element werden der Beginn und das Ende des Krankenversicherungsverhaeltnisses angegeben",
"mustSupport": true
},
{
"id": "Coverage.payor",
"path": "Coverage.payor",
"max": "1",
"type": [
{
"code": "Reference",
"targetProfile": [
"https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Organisation|1.2.0"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.payor.identifier",
"path": "Coverage.payor.identifier",
"short": "IKs",
"min": 1,
"type": [
{
"code": "Identifier",
"profile": [
"http://fhir.de/StructureDefinition/identifier-iknr"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension",
"path": "Coverage.payor.identifier.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"rules": "open"
}
},
{
"id": "Coverage.payor.identifier.extension:alternative_IK",
"path": "Coverage.payor.identifier.extension",
"sliceName": "alternative_IK",
"max": "1",
"type": [
{
"code": "Extension",
"profile": [
"https://fhir.kbv.de/StructureDefinition/KBV_EX_FOR_Alternative_IK"
]
}
],
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension:alternative_IK.value[x]:valueIdentifier",
"path": "Coverage.payor.identifier.extension.value[x]",
"sliceName": "valueIdentifier"
},
{
"id": "Coverage.payor.identifier.extension:alternative_IK.value[x]:valueIdentifier.system",
"path": "Coverage.payor.identifier.extension.value[x].system",
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.extension:alternative_IK.value[x]:valueIdentifier.value",
"path": "Coverage.payor.identifier.extension.value[x].value",
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.type.coding:XX-Type",
"path": "Coverage.payor.identifier.type.coding",
"sliceName": "XX-Type"
},
{
"id": "Coverage.payor.identifier.type.coding:XX-Type.version",
"path": "Coverage.payor.identifier.type.coding.version",
"max": "0"
},
{
"id": "Coverage.payor.identifier.type.coding:XX-Type.display",
"path": "Coverage.payor.identifier.type.coding.display",
"max": "0"
},
{
"id": "Coverage.payor.identifier.type.coding:XX-Type.userSelected",
"path": "Coverage.payor.identifier.type.coding.userSelected",
"max": "0"
},
{
"id": "Coverage.payor.identifier.system",
"path": "Coverage.payor.identifier.system",
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.value",
"path": "Coverage.payor.identifier.value",
"maxLength": 9,
"mustSupport": true
},
{
"id": "Coverage.payor.identifier.period",
"path": "Coverage.payor.identifier.period",
"max": "0"
},
{
"id": "Coverage.payor.identifier.assigner",
"path": "Coverage.payor.identifier.assigner",
"max": "0"
},
{
"id": "Coverage.payor.display",
"path": "Coverage.payor.display",
"short": "Kostenträgername",
"min": 1
},
{
"id": "Coverage.class",
"path": "Coverage.class",
"max": "0"
},
{
"id": "Coverage.order",
"path": "Coverage.order",
"max": "0"
},
{
"id": "Coverage.network",
"path": "Coverage.network",
"max": "0"
},
{
"id": "Coverage.costToBeneficiary",
"path": "Coverage.costToBeneficiary",
"max": "0"
},
{
"id": "Coverage.subrogation",
"path": "Coverage.subrogation",
"max": "0"
},
{
"id": "Coverage.contract",
"path": "Coverage.contract",
"max": "0"
}
]
}
}
FHIR