Guide d’Implémentation FHIR – Pré-admission Hospitalière en Ligne
0.1.0 - ci-build FRANCE

Guide d’Implémentation FHIR – Pré-admission Hospitalière en Ligne - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: Fr Preadmission Coverage Profile

Official URL: http://hl7.fr/fhir/fr/preadmission/StructureDefinition/preadmission-coverage-fr Version: 0.1.0
Draft as of 2026-02-24 Computable Name: PreadmissionCoverageFr

Profil Coverage pour les couvertures sociales lors de la préadmission

Introduction

La couverture sociale est un élément clé du processus de préadmission hospitalière. Elle permet de garantir que les frais médicaux du patient seront pris en charge, soit par l’Assurance Maladie Obligatoire (AMO), soit par une Assurance Maladie Complémentaire (AMC). Dans le cadre de la préadmission, ces informations sont collectées et structurées à l’aide de la ressource FHIR Coverage, enrichie d’extensions spécifiques pour répondre aux besoins administratifs et réglementaires.

Pourquoi renseigner la couverture sociale ?

La couverture sociale joue un rôle central dans la gestion administrative d’un séjour hospitalier. Elle permet :

  • D’assurer la prise en charge financière : Les informations sur l’AMO et l’AMC permettent à l’hôpital de facturer correctement les soins.
  • De vérifier les droits du patient : Les données collectées garantissent que le patient est bien couvert pour les prestations médicales prévues.
  • De simplifier les échanges administratifs : En structurant les informations selon les standards FHIR, les systèmes hospitaliers peuvent traiter efficacement les données.

Ressource FHIR : Coverage

La ressource Coverage est utilisée pour modéliser les informations relatives à la couverture sociale d’un patient. Elle inclut des champs essentiels tels que :

  • Le type de couverture : AMO (Assurance Maladie Obligatoire) ou AMC (Assurance Maladie Complémentaire).
  • Le bénéficiaire : Le patient couvert par cette assurance.
  • L’assuré principal : La personne à laquelle la couverture est rattachée (si différente du bénéficiaire).
  • La période de validité : Les dates de début et de fin de la couverture.
  • Le lien entre l’assuré et le bénéficiaire : Par exemple, parent, conjoint ou enfant.

Extensions spécifiques

Pour répondre aux besoins spécifiques de la préadmission, des extensions enrichissent la ressource Coverage :

  • FrCoverageAMCExtension : Permet de détailler les informations spécifiques à une AMC, comme le nom de l’organisme complémentaire, le numéro d’adhérent, ou encore un code de convention.

Comment renseigner une AMO ?

Pour une Assurance Maladie Obligatoire (AMO), les informations suivantes doivent être renseignées dans la ressource Coverage :

  1. Type de couverture : Utilisez le code PUBLICPOL pour indiquer qu’il s’agit d’une AMO.
  2. Bénéficiaire : Référencez le patient concerné via le champ beneficiary.
  3. Assuré principal : Si l’assuré principal est différent du bénéficiaire, renseignez le champ subscriber avec une référence vers la ressource Patient correspondante.
  4. Numéro de sécurité sociale : Renseignez le champ subscriberId avec le numéro de Sécurité Sociale de l’assuré principal.
  5. Lien entre l’assuré et le bénéficiaire : Si nécessaire, utilisez le champ relationship pour indiquer le lien (ex. parent, conjoint).

Comment renseigner une AMC ?

Pour une Assurance Maladie Complémentaire (AMC), les informations suivantes doivent être renseignées :

  1. Type de couverture : Utilisez le code EHCPOL pour indiquer qu’il s’agit d’une AMC.
  2. Bénéficiaire : Référencez le patient concerné via le champ beneficiary.
  3. Assuré principal : Si l’assuré principal est différent du bénéficiaire, renseignez le champ subscriber avec une référence vers la ressource Patient correspondante.
  4. Numéro d’adhérent : Renseignez le champ subscriberId avec le numéro d’adhérent fourni par l’organisme complémentaire.
  5. Détails spécifiques à l’AMC
    • Le numéro de l’AMC doit être renseigné comme identifier du payor (Organization), l’oid associé est 1.2.250.1.213.1.1.4.6.
    • Utilisez l’extension FrCoverageAMCExtension pour ajouter des informations comme :
      • Un code de convention ou un code CSR, si applicable.
      • Le contenu du Datamatrix, s’il est disponible.

Exemple d’échange de couverture sociale

Lors de la préadmission, le patient fournit ses informations de couverture sociale via un portail en ligne. Ces données sont ensuite transmises au système administratif de l’hôpital pour vérification. Voici un exemple de flux :

  1. Saisie par le patient : Le patient renseigne ses informations d’AMO et/ou d’AMC sur le portail de préadmission.
  2. Transmission au système administratif hospitalier : Les données sont envoyées sous forme de ressource Coverage, enrichie des extensions nécessaires.
  3. Vérification par l’agent administratif : L’agent vérifie la validité des informations (dates, numéros, etc.) et fait appel aux différents téléservices.
  4. Validation ou correction : Si tout est conforme, la couverture est validée. Sinon, une notification est envoyée au patient pour correction.

Critère de recherche autorisé

Dans le contexte de la préadmission, la ressource Coverage ne peut être recherchée qu’à partir du patient. Cela signifie que les systèmes doivent utiliser uniquement le critère patient pour interroger les informations de couverture, conformément aux contraintes d’implémentation définies.

coverage?patient=

Conclusion

La gestion de la couverture sociale dans la préadmission est essentielle pour garantir une prise en charge fluide et efficace des patients. En utilisant la ressource FHIR Coverage et ses extensions spécifiques, les établissements de santé peuvent structurer et automatiser ce processus tout en respectant les exigences réglementaires. Que ce soit pour une AMO ou une AMC, chaque détail compte pour assurer une expérience patient optimale et une gestion administrative sans faille.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices pour extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:informationsAmc S 0..1 (Complex) Informations AMC
URL: http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
.... coding Σ 1..1 Coding Code defined by a terminology system
..... code Σ 0..1 code Symbol in syntax defined by the system
Binding: type-couverture-sociale-vs (required)
... subscriber SΣ 1..1 Reference(FR Core Patient Profile | RelatedPerson) Référence vers l’assuré
... subscriberId Σ 1..1 string Numéro de sécurité sociale ou numéro d'adhérent
... beneficiary SΣ 1..1 Reference(FR Core Patient Profile) Plan beneficiary
... relationship 0..1 CodeableConcept Lien entre l’assuré et le bénéficiaire
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
.... coding Σ 1..1 Coding Code defined by a terminology system
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

PathConformitéValueSet / CodeURI
Coverage.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
From the FHIR Standard
Coverage.type.coding.coderequiredTypeCouvertureSocialeValueSet
http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs
From this IG
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
From the FHIR Standard

Constraints

IdGradePath(s)DétailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... Slices pour extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:informationsAmc S 0..1 (Complex) Informations AMC
URL: http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended
... identifier S 1..1 Identifier Business Identifier for the coverage
... status S 1..1 code active | cancelled | draft | entered-in-error
Required Pattern: active
.... coding 1..1 Coding Code defined by a terminology system
..... code 0..1 code Symbol in syntax defined by the system
Binding: type-couverture-sociale-vs (required)
... subscriber S 1..1 Reference(FR Core Patient Profile | RelatedPerson) Référence vers l’assuré
... subscriberId 1..1 string Numéro de sécurité sociale ou numéro d'adhérent
... beneficiary S 1..1 Reference(FR Core Patient Profile) Plan beneficiary
... relationship 0..1 CodeableConcept Lien entre l’assuré et le bénéficiaire
.... coding 1..1 Coding Code defined by a terminology system

doco Documentation for this format

Terminology Bindings (Differential)

PathConformitéValueSetURI
Coverage.type.coding.coderequiredTypeCouvertureSocialeValueSet
http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs
From this IG
NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices pour extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:informationsAmc S 0..1 (Complex) Informations AMC
URL: http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 1..1 Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 1..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 0..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 0..1 code Symbol in syntax defined by the system
Binding: type-couverture-sociale-vs (required)
..... display Σ 0..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber SΣ 1..1 Reference(FR Core Patient Profile | RelatedPerson) Référence vers l’assuré
... subscriberId Σ 1..1 string Numéro de sécurité sociale ou numéro d'adhérent
... beneficiary SΣ 1..1 Reference(FR Core Patient Profile) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Lien entre l’assuré et le bénéficiaire
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 1..1 Coding Code defined by a terminology system
.... text Σ 0..1 string Plain text representation of the concept
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

PathConformitéValueSet / CodeURI
Coverage.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
From the FHIR Standard
Bindings Additionnels But
AllLanguages Binding Max
Coverage.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
From the FHIR Standard
Coverage.type.coding.coderequiredTypeCouvertureSocialeValueSet
http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs
From this IG
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
From the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
From the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
From the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
From the FHIR Standard

Constraints

IdGradePath(s)DétailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Résumé

Mandatory: 5 elements(1 nested mandatory element)
Must-Support: 6 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Key Elements View

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices pour extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:informationsAmc S 0..1 (Complex) Informations AMC
URL: http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
.... coding Σ 1..1 Coding Code defined by a terminology system
..... code Σ 0..1 code Symbol in syntax defined by the system
Binding: type-couverture-sociale-vs (required)
... subscriber SΣ 1..1 Reference(FR Core Patient Profile | RelatedPerson) Référence vers l’assuré
... subscriberId Σ 1..1 string Numéro de sécurité sociale ou numéro d'adhérent
... beneficiary SΣ 1..1 Reference(FR Core Patient Profile) Plan beneficiary
... relationship 0..1 CodeableConcept Lien entre l’assuré et le bénéficiaire
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
.... coding Σ 1..1 Coding Code defined by a terminology system
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy

doco Documentation for this format

Terminology Bindings

PathConformitéValueSet / CodeURI
Coverage.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
From the FHIR Standard
Coverage.type.coding.coderequiredTypeCouvertureSocialeValueSet
http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs
From this IG
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
From the FHIR Standard

Constraints

IdGradePath(s)DétailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

Differential View

This structure is derived from Coverage

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... Slices pour extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:informationsAmc S 0..1 (Complex) Informations AMC
URL: http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended
... identifier S 1..1 Identifier Business Identifier for the coverage
... status S 1..1 code active | cancelled | draft | entered-in-error
Required Pattern: active
.... coding 1..1 Coding Code defined by a terminology system
..... code 0..1 code Symbol in syntax defined by the system
Binding: type-couverture-sociale-vs (required)
... subscriber S 1..1 Reference(FR Core Patient Profile | RelatedPerson) Référence vers l’assuré
... subscriberId 1..1 string Numéro de sécurité sociale ou numéro d'adhérent
... beneficiary S 1..1 Reference(FR Core Patient Profile) Plan beneficiary
... relationship 0..1 CodeableConcept Lien entre l’assuré et le bénéficiaire
.... coding 1..1 Coding Code defined by a terminology system

doco Documentation for this format

Terminology Bindings (Differential)

PathConformitéValueSetURI
Coverage.type.coding.coderequiredTypeCouvertureSocialeValueSet
http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs
From this IG

Snapshot View

NomDrapeauxCard.TypeDescription et contraintes    Filter: Filtersdoco
.. Coverage 0..* Coverage Insurance or medical plan or a payment agreement
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices pour extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:informationsAmc S 0..1 (Complex) Informations AMC
URL: http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 1..1 Identifier Business Identifier for the coverage
... status ?!SΣ 1..1 code active | cancelled | draft | entered-in-error
Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Required Pattern: active
... type SΣ 1..1 CodeableConcept Coverage category such as medical or accident
Binding: CoverageTypeAndSelf-PayCodes (preferred): The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 1..1 Coding Code defined by a terminology system
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ 0..1 uri Identity of the terminology system
..... version Σ 0..1 string Version of the system - if relevant
..... code Σ 0..1 code Symbol in syntax defined by the system
Binding: type-couverture-sociale-vs (required)
..... display Σ 0..1 string Representation defined by the system
..... userSelected Σ 0..1 boolean If this coding was chosen directly by the user
.... text Σ 0..1 string Plain text representation of the concept
... policyHolder Σ 0..1 Reference(Patient | RelatedPerson | Organization) Owner of the policy
... subscriber SΣ 1..1 Reference(FR Core Patient Profile | RelatedPerson) Référence vers l’assuré
... subscriberId Σ 1..1 string Numéro de sécurité sociale ou numéro d'adhérent
... beneficiary SΣ 1..1 Reference(FR Core Patient Profile) Plan beneficiary
... dependent Σ 0..1 string Dependent number
... relationship 0..1 CodeableConcept Lien entre l’assuré et le bénéficiaire
Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 1..1 Coding Code defined by a terminology system
.... text Σ 0..1 string Plain text representation of the concept
... period Σ 0..1 Period Coverage start and end dates
... payor Σ 1..* Reference(Organization | Patient | RelatedPerson) Issuer of the policy
... class 0..* BackboneElement Additional coverage classifications
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 1..1 CodeableConcept Type of class such as 'group' or 'plan'
Binding: CoverageClassCodes (extensible): The policy classifications, eg. Group, Plan, Class, etc.
.... value Σ 1..1 string Value associated with the type
.... name Σ 0..1 string Human readable description of the type and value
... order Σ 0..1 positiveInt Relative order of the coverage
... network Σ 0..1 string Insurer network
... costToBeneficiary 0..* BackboneElement Patient payments for services/products
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

PathConformitéValueSet / CodeURI
Coverage.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
From the FHIR Standard
Bindings Additionnels But
AllLanguages Binding Max
Coverage.statusrequiredPattern Value: active
http://hl7.org/fhir/ValueSet/fm-status|4.0.1
From the FHIR Standard
Coverage.typepreferredCoverageTypeAndSelf-PayCodes
http://hl7.org/fhir/ValueSet/coverage-type
From the FHIR Standard
Coverage.type.coding.coderequiredTypeCouvertureSocialeValueSet
http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs
From this IG
Coverage.relationshipextensibleSubscriberRelationshipCodes
http://hl7.org/fhir/ValueSet/subscriber-relationship
From the FHIR Standard
Coverage.class.typeextensibleCoverageClassCodes
http://hl7.org/fhir/ValueSet/coverage-class
From the FHIR Standard
Coverage.costToBeneficiary.typeextensibleCoverageCopayTypeCodes
http://hl7.org/fhir/ValueSet/coverage-copay-type
From the FHIR Standard
Coverage.costToBeneficiary.exception.typeexampleExampleCoverageFinancialExceptionCodes
http://hl7.org/fhir/ValueSet/coverage-financial-exception
From the FHIR Standard

Constraints

IdGradePath(s)DétailsRequirements
dom-2errorCoverageIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorCoverageIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
: contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4errorCoverageIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5errorCoverageIf a resource is contained in another resource, it SHALL NOT have a security label
: contained.meta.security.empty()
dom-6best practiceCoverageA resource should have narrative for robust management
: text.`div`.exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()

This structure is derived from Coverage

Résumé

Mandatory: 5 elements(1 nested mandatory element)
Must-Support: 6 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron