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Source1

{
  "resourceType": "StructureDefinition",
  "id": "profile-prior-coverage",
  "url": "http://pharmacyeclaims.ca/FHIR/v1.0/StructureDefinition/profile-prior-coverage",
  "name": "PriorCoverage",
  "title": "Prior Coverage",
  "status": "draft",
  "description": "Profile for prior coverages in a claim",
  "purpose": "Used specifically for prior coverages in a claim, with less information than typical coverages",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "Coverage",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Coverage",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Coverage.text",
        "path": "Coverage.text",
        "max": "0"
      },
      {
        "id": "Coverage.status",
        "path": "Coverage.status",
        "comment": "Set value = \"active\"\r\n\r\nThis element is labeled as a modifier because the status contains the code entered-in-error that marks the coverage as not currently valid.",
        "fixedCode": "active",
        "mustSupport": true
      },
      {
        "id": "Coverage.subscriber",
        "path": "Coverage.subscriber",
        "max": "0"
      },
      {
        "id": "Coverage.beneficiary",
        "path": "Coverage.beneficiary",
        "mustSupport": true
      },
      {
        "id": "Coverage.payor",
        "path": "Coverage.payor",
        "comment": "Usage Note:  If the adjudicator does not wish to share the payor identity with a downstream payor, the display name may be used to indicate \"unavailable\"\r\nMay provide multiple identifiers such as insurance company identifier or business identifier (BIN number).\nFor selfpay it may provide multiple paying persons and/or organizations.",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Organization"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "Coverage.payor.identifier",
        "path": "Coverage.payor.identifier",
        "comment": "Usage Note:   This will only be specified under specific condtions as specified by the implementer (eg same payor identifier as secondary claim)\r\n\r\nWhen an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference.  For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport).  One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).",
        "mustSupport": true
      },
      {
        "id": "Coverage.payor.display",
        "path": "Coverage.payor.display",
        "comment": "Usage Note:  Must be populated if no identifier is provided.   A value of \"unavailable\" is acceptable.\r\n\r\nThis is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
        "mustSupport": true
      },
      {
        "id": "Coverage.contract",
        "path": "Coverage.contract",
        "comment": "Usage Note:  If the adjudicator wishes to share the contract/policy information with downstream payors, this may be included, eg when the adjudicator is the same.  \r\n\r\nReferences SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (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.",
        "mustSupport": true
      },
      {
        "id": "Coverage.contract.identifier",
        "path": "Coverage.contract.identifier",
        "mustSupport": true
      }
    ]
  }
}