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:

- Examples for this Profile: Coverage/coverage-amc, Coverage/coverage-amo-enfant and Coverage/coverage-amo
- CapabilityStatements using this Profile: Capacités serveur FHIR pour l'IG Preadmission

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.

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Nom | Drapeaux | Card. | Type | Description et contraintes Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
identifier | S Σ | 1..1 | Identifier | Business Identifier for the coverage
status | ?!S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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
Documentation for this format

#### Terminology Bindings

Path | Conformité | ValueSet / Code | URI
Coverage.status | required | Pattern Value: active `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Coverage.type | preferred | CoverageTypeAndSelf-PayCodes `http://hl7.org/fhir/ValueSet/coverage-type` From the FHIR Standard
Coverage.type.coding.code | required | TypeCouvertureSocialeValueSet `http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs` From this IG
Coverage.relationship | extensible | SubscriberRelationshipCodes `http://hl7.org/fhir/ValueSet/subscriber-relationship` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Détails | Requirements
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |

This structure is derived from Coverage

Nom | Drapeaux | Card. | Type | Description et contraintes Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident
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
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformité | ValueSet | URI
Coverage.type.coding.code | required | TypeCouvertureSocialeValueSet `http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs` From this IG

Nom | Drapeaux | Card. | Type | Description et contraintes Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Bindings Additionnels | But
AllLanguages | Binding Max
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 | S Σ | 1..1 | Identifier | Business Identifier for the coverage
status | ?!S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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
Documentation for this format

#### Terminology Bindings

Path | Conformité | ValueSet / Code | URI
Coverage.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Bindings Additionnels | But
AllLanguages | Binding Max
Coverage.status | required | Pattern Value: active `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Coverage.type | preferred | CoverageTypeAndSelf-PayCodes `http://hl7.org/fhir/ValueSet/coverage-type` From the FHIR Standard
Coverage.type.coding.code | required | TypeCouvertureSocialeValueSet `http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs` From this IG
Coverage.relationship | extensible | SubscriberRelationshipCodes `http://hl7.org/fhir/ValueSet/subscriber-relationship` From the FHIR Standard
Coverage.class.type | extensible | CoverageClassCodes `http://hl7.org/fhir/ValueSet/coverage-class` From the FHIR Standard
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes `http://hl7.org/fhir/ValueSet/coverage-copay-type` From the FHIR Standard
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes `http://hl7.org/fhir/ValueSet/coverage-financial-exception` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Détails | Requirements
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must 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:

- FR Core Patient Profile (https://hl7.fr/ig/fhir/core/StructureDefinition/fr-core-patient)

Extensions

This structure refers to these extensions:

- http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended

Key Elements View

Nom | Drapeaux | Card. | Type | Description et contraintes Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
identifier | S Σ | 1..1 | Identifier | Business Identifier for the coverage
status | ?!S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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
Documentation for this format

#### Terminology Bindings

Path | Conformité | ValueSet / Code | URI
Coverage.status | required | Pattern Value: active `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Coverage.type | preferred | CoverageTypeAndSelf-PayCodes `http://hl7.org/fhir/ValueSet/coverage-type` From the FHIR Standard
Coverage.type.coding.code | required | TypeCouvertureSocialeValueSet `http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs` From this IG
Coverage.relationship | extensible | SubscriberRelationshipCodes `http://hl7.org/fhir/ValueSet/subscriber-relationship` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Détails | Requirements
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |

Differential View

This structure is derived from Coverage

Nom | Drapeaux | Card. | Type | Description et contraintes Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
type | S | 1..1 | CodeableConcept | Coverage category such as medical or accident
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
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformité | ValueSet | URI
Coverage.type.coding.code | required | TypeCouvertureSocialeValueSet `http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs` From this IG

Snapshot View

Nom | Drapeaux | Card. | Type | Description et contraintes Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Bindings Additionnels | But
AllLanguages | Binding Max
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 | S Σ | 1..1 | Identifier | Business Identifier for the coverage
status | ?!S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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
Documentation for this format

#### Terminology Bindings

Path | Conformité | ValueSet / Code | URI
Coverage.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Bindings Additionnels | But
AllLanguages | Binding Max
Coverage.status | required | Pattern Value: active `http://hl7.org/fhir/ValueSet/fm-status|4.0.1` From the FHIR Standard
Coverage.type | preferred | CoverageTypeAndSelf-PayCodes `http://hl7.org/fhir/ValueSet/coverage-type` From the FHIR Standard
Coverage.type.coding.code | required | TypeCouvertureSocialeValueSet `http://hl7.fr/fhir/fr/preadmission/ValueSet/type-couverture-sociale-vs` From this IG
Coverage.relationship | extensible | SubscriberRelationshipCodes `http://hl7.org/fhir/ValueSet/subscriber-relationship` From the FHIR Standard
Coverage.class.type | extensible | CoverageClassCodes `http://hl7.org/fhir/ValueSet/coverage-class` From the FHIR Standard
Coverage.costToBeneficiary.type | extensible | CoverageCopayTypeCodes `http://hl7.org/fhir/ValueSet/coverage-copay-type` From the FHIR Standard
Coverage.costToBeneficiary.exception.type | example | ExampleCoverageFinancialExceptionCodes `http://hl7.org/fhir/ValueSet/coverage-financial-exception` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Détails | Requirements
dom-2 | error | Coverage | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Coverage | If 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-4 | error | Coverage | If 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-5 | error | Coverage | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Coverage | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must 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:

- FR Core Patient Profile (https://hl7.fr/ig/fhir/core/StructureDefinition/fr-core-patient)

Extensions

This structure refers to these extensions:

- http://hl7.fr/fhir/fr/preadmission/StructureDefinition/fr-coverage-amc-extended

Other representations of profile: CSV, Excel, Schematron