Name Flags Card. Type Description & Constraints Coverage 0..* Coverage 保険情報、公費情報 id S 0..1 string このリソースのID text S 0..1 Narrative このリソースの概要 status S 1..1 code generated | extensions | additional | empty Fixed Value: generated div S 1..1 xhtml このリソースの概要 Slices for extension S 0..* Extension Extension Slice: Unordered, Open by value:url StructureDefinition-JP-REZEPT-ExtensionCoverageInsuredPersonSymbol.html S 0..* string 被保険者証記号を表す拡張 URL: https://igs.healthdataworks.net/jp-rezept-medication/StructureDefinition-JP-REZEPT-ExtensionCoverageInsuredPersonSymbol.html StructureDefinition-JP-REZEPT-ExtensionCoverageInsuredPersonNo.html S 0..* string 被保険者証番号を表す拡張 URL: https://igs.healthdataworks.net/jp-rezept-medication/StructureDefinition-JP-REZEPT-ExtensionCoverageInsuredPersonNo.html status S 1..1 code 保険情報、公費情報の状態 type S 0..1 CodeableConcept 保険種別 coding S 0..* Coding 保険種別 system S 0..1 uri 保険種別のOID code S 0..1 code 保険種別コード display S 0..1 string 保険種別の名称 subscriber S 0..1 Reference(Patient | RelatedPerson) 被保険者(患者)情報の参照 reference S 0..1 string 被保険者(患者)情報の参照 subscriberId S 0..1 string 受診券整理番号 beneficiary S 1..1 Reference(Patient) 患者の参照 reference S 0..1 string この保険で給付される患者の参照 dependent S 0..1 string 被保険者の枝番号 relationship S 0..1 CodeableConcept 患者との関係区分 coding S 0..* Coding 患者との関係区分 system S 0..1 uri 患者との関係区分のOID Fixed Value: urn:oid:1.2.392.100495.20.2.62 code S 0..1 code 患者との関係区分コード display S 0..1 string 患者との関係区分コードの名称 period S 0..1 Period 保険証の有効期間 start S 0..1 dateTime 保険証の有効開始日 end S 0..1 dateTime 保険証の有効期限日 payor S 1..* Reference(Organization | Patient | RelatedPerson) 保険者の参照 reference S 0..1 string 保険者の参照 class S 0..* BackboneElement 保険(公費)区分 type S 1..1 CodeableConcept 保険(公費)区分 coding S 0..* Coding 保険(公費)区分 system S 0..1 uri 保険(公費)区分のOID code S 0..1 code 保険(公費)区分コード Binding: 負担者種別コード (required) display S 0..1 string 保険(公費)区分コードの名称 value S 1..1 string 保険(公費)番号 name S 0..1 string 保険(公費)名称 Fixed Value: 公費負担者番号 order S 0..1 positiveInt 保険適用順序 costToBeneficiary S 0..* BackboneElement Patient payments for services/products value[x] S 1..1 SimpleQuantity, Money The amount or percentage due from the beneficiary Example Example for Quantity: {"unit":"%"} Documentation for this format
保険情報、公費情報です。 医療サービスや調剤等の請求額と自己負担金の両方が含まれます。
Canadian Dental Association eclaims standard
Canadian Pharmacy Associaiton eclaims standard
レセプト電算処理システムの請求に係る記録条件仕様(歯科用)をFHIRにマッピングします。
レセプト電算処理システムの請求に係る記録条件仕様(DPC用)をFHIRにマッピングします。
レセプト電算処理システムの請求に係る記録条件仕様(医科用)をFHIRにマッピングします。
レセプト電算処理システムの請求に係る記録条件仕様(調剤用)をFHIRにマッピングします。
レセプト電算処理システムの加入者情報をFHIRにマッピングします。
保険対象者(患者)と保険者の間のリンクを提供します。
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
保険者向け例: ・保険者番号 ・被保険者証記号 ・被保険者証番号 公費向け例: ・負担者番号 ・受給者番号
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
generated | extensions | additional | empty
このリソースの概要がリソースのコンテンツから⽣成されたことを⽰す。
The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.
The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, elements (either name or href), images and internally contained style attributes
not(descendant-or-self::*[not(local-name(.)=('a', 'abbr', 'acronym', 'b', 'big', 'blockquote', 'br', 'caption', 'cite', 'code', 'col', 'colgroup', 'dd', 'dfn', 'div', 'dl', 'dt', 'em', 'h1', 'h2', 'h3', 'h4', 'h5', 'h6', 'hr', 'i', 'img', 'li', 'ol', 'p', 'pre', 'q', 'samp', 'small', 'span', 'strong', 'sub', 'sup', 'table', 'tbody', 'td', 'tfoot', 'th', 'thead', 'tr', 'tt', 'ul', 'var'))]) and not(descendant-or-self::*/@*[not(name(.)=('abbr', 'accesskey', 'align', 'alt', 'axis', 'bgcolor', 'border', 'cellhalign', 'cellpadding', 'cellspacing', 'cellvalign', 'char', 'charoff', 'charset', 'cite', 'class', 'colspan', 'compact', 'coords', 'dir', 'frame', 'headers', 'height', 'href', 'hreflang', 'hspace', 'id', 'lang', 'longdesc', 'name', 'nowrap', 'rel', 'rev', 'rowspan', 'rules', 'scope', 'shape', 'span', 'src', 'start', 'style', 'summary', 'tabindex', 'title', 'type', 'valign', 'value', 'vspace', 'width'))])
The narrative SHALL have some non-whitespace content
descendant::text()[normalize-space(.)!=''] or descendant::h:img[@src]
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
被保険者証記号を表す拡張「InsuredPersonSymbol」です。保険種別が「1:医保」、「2:国保」の場合に記録します。被保険者証記号がない場合は、本拡張要素は出現しません。
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
被保険者証番号を表す拡張「InsuredPersonNumber」です。保険種別が「1:医保」、「2:国保」、「7:後期⾼齢者」の場合に記録します。それ以外の場合は、本拡張要素は出現しません。
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
A unique identifier assigned to this coverage.
The main (and possibly only) identifier for the coverage - often referred to as a Member Id, Certificate number, Personal Health Number or Case ID. May be constructed as the concatenation of the Coverage.SubscriberID and the Coverage.dependant.
Allows coverages to be distinguished and referenced.
保険情報、公費情報では「active」固定とします。
Need to track the status of the resource as 'draft' resources may undergo further edits while 'active' resources are immutable and may only have their status changed to 'cancelled'.
This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
A code specifying the state of the resource instance.
The order of application of coverages is dependent on the types of coverage.
The type of insurance: public health, worker compensation; private accident, auto, private health, etc.) or a direct payment by an individual or organization.
Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.
Allows for alternative encodings within a code system, and translations to other code systems.
fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.
Need to be unambiguous about the source of the definition of the symbol.
fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.
fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
医療保険として作成する場合は「1～7」、公費として作成する場合は「8」になる。 1:医保 2:国保 3:労災 4:自賠 5:公害 6:自費 7:後期高齢者 8:公費
Need to refer to a particular code in the system.
fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
保険者番号から該当するコード(1:医保、2:国保、、3:労災、4:自賠、5:公害、6:自費、7:後期高齢者、8:公費)を決める。
Need to be able to carry a human-readable meaning of the code for readers that do not know the system.
C*E.2 - but note this is not well followed
fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
If this coding was chosen directly by the user
Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.
This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.
fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]
Plain text representation of the concept
A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Very often the text is the same as a displayName of one of the codings.
The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
The party who 'owns' the insurance policy.
For example: may be an individual, corporation or the subscriber's employer.
This provides employer information in the case of Worker's Compensation and other policies.
IN1-16, 18, 19-name of insured, address, date of birth
May be self or a parent in the case of dependants.
This is the party who is entitled to the benfits under the policy.
Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.
保険者レコード(HO).保険者番号、保険者レコード(HO).被保険者証(手帳)の記号・番号
加入者情報.保険者番号、加入者情報.被保険者証(手帳)の記号・番号
Type the reference refers to (e.g. "Patient")
The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.
Aa resource (or, for logical models, the URI of the logical model).
Logical reference, when literal reference is not known
An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
When 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. When 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 Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference 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).
Plain text narrative that identifies the resource in addition to the resource reference.
This 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.
The insurer requires this identifier on correspondance and claims (digital and otherwise).
XML No: 9.6.1 XPath: /ClinicalDocument/participant/associatedEntity/id/@extension
This is the party who receives treatment for which the costs are reimbursed under the coverage.
この保険で給付される患者の参照
この保険で給付される患者の参照です。
Periodically the member number is constructed from the subscriberId and the dependant number.
For some coverages a single identifier is issued to the Subscriber and then a unique dependent number is issued to each beneficiary.
- No exact HL7 v2 equivalent concept seems to exist;
Typically, an individual uses policies which are theirs (relationship='self') before policies owned by others.
To determine relationship between the patient and the subscriber to determine coordination of benefits.
The relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
加入者情報の「続柄」が無ければ「1」、あれば「2」。 1:被保険者 2:被扶養者
患者との関係区分コードの名称です。
Some insurers require the submission of the coverage term.
If the low element is missing, the meaning is that the low boundary is not known.
The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.
If the end of the period is missing, it means that the period is ongoing
May provide multiple identifiers such as insurance company identifier or business identifier (BIN number). For selfpay it may provide multiple paying persons and/or organizations.
Need to identify the issuer to target for claim processing and for coordination of benefit processing.
For example may be used to identify a class of coverage or employer group, Policy, Plan.
The codes provided on the health card which identify or confirm the specific policy for the insurer.
Extensions that cannot be ignored even if unrecognized
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
The insurer issued label for a specific health card value.
The policy classifications, eg. Group, Plan, Class, etc.
1:医療保険、国民健康保険、退職者医療又は後期高齢者医療 2:第１公費負担医療 3:第２公費負担医療 4:第３公費負担医療 5:第４公費負担医療
資格確認レコード(SN).負担者種別コード
The insurer issued label and value are necessary to identify the specific policy.
Used to provide a meaningful description in correspondence to the patient.
保険(公費)区分コードをそのまま優先度にする。 1:医療保険、国民健康保険、退職者医療又は後期高齢者医療 2:第１公費負担医療 3:第２公費負担医療 4:第３公費負担医療 5:第４公費負担医療
Used in managing the coordination of benefits.
The insurer-specific identifier for the insurer-defined network of providers to which the beneficiary may seek treatment which will be covered at the 'in-network' rate, otherwise 'out of network' terms and conditions apply.
Used in referral for treatment and in claims processing.
A suite of codes indicating the cost category and associated amount which have been detailed in the policy and may have been included on the health card.
For example by knowing the patient visit co-pay, the provider can collect the amount prior to undertaking treatment.
Required by providers to manage financial transaction with the patient.
The category of patient centric costs associated with treatment.
For example visit, specialist visits, emergency, inpatient care, etc.
Needed to identify the category associated with the amount for the patient.
The types of services to which patient copayments are specified.
The amount or percentage due from the beneficiary
The amount due from the patient for the cost category.
Amount may be expressed as a percentage of the service/product cost or a fixed amount of currency.
Needed to identify the amount for the patient associated with the category.
A suite of codes indicating exceptions or reductions to patient costs and their effective periods.
Needed to identify the exception associated with the amount for the patient.
The types of exceptions from the part or full value of financial obligations such as copays.
The timeframe during when the exception is in force.
Needed to identify the applicable timeframe for the exception for the correct calculation of patient costs.
When 'subrogation=true' this insurance instance has been included not for adjudication but to provide insurers with the details to recover costs.
Typically, automotive and worker's compensation policies would be flagged with 'subrogation=true' to enable healthcare payors to collect against accident claims.
The policy(s) which constitute this insurance coverage.
To reference the legally binding contract between the policy holder and the insurer.