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Packageke.fhir.eclaims
Resource TypeCoverage
IdCoverage-ECLM-COV-001.json
FHIR VersionR4

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Coverage ECLM-COV-001

Profiles: Coverage Profile, https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-coverage

Tag: Actionable (Details: Common Tags code actionable = 'Actionable')

Paymen tMethod Extension: Mobile Money

Current member status Extension: Active

Annual Limits Category Extension: General Practice

identifier: https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number/COV-SHA-2024-001234

status: Active

type: Medical

subscriber: John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678 (use: official, ))

beneficiary: John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678 (use: official, ))

relationship: Self

period: 2024-01-01 --> 2024-12-31

payor: Organization Social Health Authority

Classes

-TypeValueName
*GroupSHA-SOCIAL-001SHA Social Health Scheme

Source1

{
  "resourceType": "Coverage",
  "id": "ECLM-COV-001",
  "meta": {
    "profile": [
      "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-coverage",
      "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-coverage"
    ],
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/common-tags",
        "code": "actionable",
        "display": "Actionable"
      }
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-payment-method-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/payment-method-cs",
            "code": "MOBILE-MONEY",
            "display": "Mobile Money"
          }
        ]
      }
    },
    {
      "url": "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-member-status-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-member-status-cs",
            "code": "ACTIVE",
            "display": "Active"
          }
        ]
      }
    },
    {
      "url": "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-annual-limit-category-extension",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/service-category",
            "code": "17",
            "display": "General Practice"
          }
        ]
      }
    }
  ],
  "identifier": [
    {
      "system": "https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number",
      "value": "COV-SHA-2024-001234"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-type-cs",
        "code": "MEDICAL",
        "display": "Medical"
      }
    ]
  },
  "subscriber": {
    "reference": "Patient/ECLM-PT-001"
  },
  "beneficiary": {
    "reference": "Patient/ECLM-PT-001",
    "type": "Patient"
  },
  "relationship": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code": "self",
        "display": "Self"
      }
    ]
  },
  "period": {
    "start": "2024-01-01",
    "end": "2024-12-31"
  },
  "payor": [
    {
      "reference": "Organization/ECLM-INS-001"
    }
  ],
  "class": [
    {
      "type": {
        "coding": [
          {
            "system": "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-class-cs",
            "code": "GROUP",
            "display": "Group"
          }
        ]
      },
      "value": "SHA-SOCIAL-001",
      "name": "SHA Social Health Scheme"
    }
  ]
}