German Practice Management FHIR Profiles (R4)
0.49.0 - STU1
German Practice Management FHIR Profiles (R4)
0.49.0 - STU1
German Practice Management FHIR Profiles (R4) - Local Development build (v0.49.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://fhir.cognovis.de/praxis/StructureDefinition/fpde-coverage-gkv | Version: 0.49.0 | |||
| Active as of 2026-05-04 | Computable Name: FPDECoverageGKV | |||
| Other Identifiers: OID:2.16.840.1.113883.3.7985.42.65 | ||||
GKV-Versicherung. Basiert auf coverage-de-gkv aus de.basisprofil.r4 (inkl. WOP und KrankenversichertenID).
Usages:
You can also check for usages in the FHIR IG Statistics
Description of Profiles, Differentials, Snapshots and how the different presentations work.
| Name | Flags | Card. | Type | Description & Constraints Filter:   |
|---|---|---|---|---|
  Coverage |
0..* | CoverageDeGkv | Versicherungsdaten | |
  implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
  Slices for extension |
Content/Rules for all slices | |||
   extension:einlesedatumKarte |
0..1 | dateTime | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte | |
| extension:onlinepruefung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk | |
| extension:versionEgk |
0..1 | string | eGK Version (z.B. 5.2.0) URL: http://fhir.de/StructureDefinition/gkv/version-vsdm | |
| extension:generationEgk |
0..* | string | eGK Generation ( 1 | 1+ | 2 ) URL: http://fhir.de/StructureDefinition/gkv/generation-egk | |
| extension:versichertenart |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/versichertenart Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required) | |
| extension:kostenerstattung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung | |
| extension:wop |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/wop Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_ITA_WOP (required) | |
| extension:besonderePersonengruppe |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required) | |
| extension:dmpKennzeichen |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_DMP (required) | |
| extension:ruhenderLeistungsanspruch |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch | |
 extension:zuzahlungsstatus |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus | |
 modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url |
| Slices for identifier |
Σ | 1..* | Identifier | Primärer Identifier der Versicherung Slice: Unordered, Open by pattern:$this |
 identifier:KrankenversichertenID |
Σ | 0..1 | IdentifierKvid10 | An identifier intended for computation Required Pattern: At least the following |
  id |
0..1 | string | Unique id for inter-element referencing | |
 extension |
0..* | Extension | Additional content defined by implementations | |
| period |
0..1 | Period | Time period when id is/was valid for use | |
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
 type |
ΣC | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Kvid DeBasis ValueSet (required): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Constraints: kvid-2 Fixed Value: (Complex) |
 id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
 coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |
| display |
0..1 | string | Representation defined by the system | |
 userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| text |
0..1 | string | Plain text representation of the concept | |
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 |
 value |
ΣC | 1..1 | string | The value that is unique Constraints: kvid-1 Example General: 123456 |
 identifier:pseudo-Krankenversichertennummer |
Σ | 0..1 | IdentifierPseudoKvid | pseudonymisierte Krankenversichertennummer Required Pattern: At least the following |
 id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| period |
0..1 | Period | Time period when id is/was valid for use | |
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: ANON | |
| display |
0..1 | string | Representation defined by the system | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| text |
0..1 | string | Plain text representation of the concept | |
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/pseudo-kvid |
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| type |
Σ | 1..1 | CodeableConcept | Versicherungsart Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt |
 Slices for coding |
Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this |
| coding:VersicherungsArtDeBasis |
Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |
| display |
0..1 | string | Representation defined by the system | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
 beneficiary |
ΣC | 1..1 | Reference(Patient) | Begünstigte Person Constraints: ref-1 |
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| identifier |
Σ | 0..1 | Identifier | Identifier der versicherten Person Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| use |
0..1 | code | usual | official | temp | secondary | old (If known) | |
| type |
0..1 | CodeableConcept | Description of identifier | |
| system |
1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | |
| value |
0..1 | string | The value that is unique | |
| period |
0..1 | Period | Time period when id is/was valid for use | |
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |
| payor |
ΣC | 1..1 | Reference(Organization | Patient | RelatedPerson) | Versicherer Constraints: ref-1 |
| Slices for extension |
Content/Rules for all slices | |||
| extension:abrechnendeIK |
0..1 | IdentifierIknr | Optional Extensions Element URL: http://fhir.de/StructureDefinition/AbrechnendeIK | |
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| display |
Σ | 1..1 | string | Text alternative for the resource |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.identifier:KrankenversichertenID.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:KrankenversichertenID.type | Base | required | Identifier Type Kvid DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.identifier:pseudo-Krankenversichertennummer.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:pseudo-Krankenversichertennummer.type | Base | extensible | Identifier Type DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | required | VersicherungsartDeBasisVS | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
| kvid-1 | warning | Coverage.identifier:KrankenversichertenID.value | Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen |
matches('^[A-Z][0-9]{9}$')
|
| kvid-2 | warning | Coverage.identifier:KrankenversichertenID.type | Die type Codes 'GKV' und 'PKV' haben den Status 'retired', daher sollen diese nicht mehr verwendet werden |
($this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='GKV') or $this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='PKV')).not()
|
| ref-1 | error | Coverage.beneficiary, Coverage.payor | SHALL have a contained resource if a local reference is provided |
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
|
This structure is derived from CoverageDeGkv
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Coverage |
0..* | CoverageDeGkv | Versicherungsdaten | |
| Documentation for this format | ||||
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Coverage |
0..* | CoverageDeGkv | Versicherungsdaten | |||||
| 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.
| |||||
| 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 for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:einlesedatumKarte |
0..1 | dateTime | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte | |||||
| extension:onlinepruefung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk | |||||
| extension:versionEgk |
0..1 | string | eGK Version (z.B. 5.2.0) URL: http://fhir.de/StructureDefinition/gkv/version-vsdm | |||||
| extension:generationEgk |
0..* | string | eGK Generation ( 1 | 1+ | 2 ) URL: http://fhir.de/StructureDefinition/gkv/generation-egk | |||||
| extension:versichertenart |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/versichertenart Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required) | |||||
| extension:kostenerstattung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung | |||||
| extension:wop |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/wop Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_ITA_WOP (required) | |||||
| extension:besonderePersonengruppe |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required) | |||||
| extension:dmpKennzeichen |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_DMP (required) | |||||
| extension:ruhenderLeistungsanspruch |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch | |||||
| extension:zuzahlungsstatus |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url | ||||
| Slices for identifier |
Σ | 1..* | Identifier | Primärer Identifier der Versicherung Slice: Unordered, Open by pattern:$this | ||||
| identifier:KrankenversichertenID |
Σ | 0..1 | IdentifierKvid10 | An identifier intended for computation Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
ΣC | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Kvid DeBasis ValueSet (required): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Constraints: kvid-2 Fixed Value: (Complex) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | ||||
| value |
ΣC | 1..1 | string | The value that is unique Constraints: kvid-1 Example General: 123456 | ||||
| period |
ΣC | 0..1 | Period | Time period when id is/was valid for use Constraints: per-1 | ||||
| assigner |
ΣC | 0..1 | Reference(Organization) | Organization that issued id (may be just text) Constraints: ref-1 | ||||
| identifier:pseudo-Krankenversichertennummer |
Σ | 0..1 | IdentifierPseudoKvid | pseudonymisierte Krankenversichertennummer Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: ANON | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/pseudo-kvid | ||||
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period |
ΣC | 0..1 | Period | Time period when id is/was valid for use Constraints: per-1 | ||||
| assigner |
ΣC | 0..1 | Reference(Organization) | Organization that issued id (may be just text) Constraints: ref-1 | ||||
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| type |
Σ | 1..1 | CodeableConcept | Versicherungsart Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| Slices for coding |
Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this | ||||
| coding:VersicherungsArtDeBasis |
Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| subscriber |
ΣC | 0..1 | Reference(Patient | RelatedPerson) | Hauptversicherte Person / Mitglied Constraints: ref-1 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | VersichertenID (10-stellig) des Hauptversicherten Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) | |||||
| type |
0..1 | CodeableConcept | Description of identifier | |||||
| system |
1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | |||||
| value |
0..1 | string | The value that is unique | |||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
| display |
Σ | 0..1 | string | Name des Hauptversicherten | ||||
| beneficiary |
ΣC | 1..1 | Reference(Patient) | Begünstigte Person Constraints: ref-1 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | Identifier der versicherten Person Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) | |||||
| type |
0..1 | CodeableConcept | Description of identifier | |||||
| system |
1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | |||||
| value |
0..1 | string | The value that is unique | |||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
| display |
Σ | 0..1 | string | Name der Versicherten Person | ||||
| dependent |
Σ | 0..1 | string | Dependent number | ||||
| relationship |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
| period |
ΣC | 0..1 | Period | Coverage start and end dates Constraints: per-1 | ||||
| payor |
ΣC | 1..1 | Reference(Organization | Patient | RelatedPerson) | Versicherer Constraints: ref-1 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:abrechnendeIK |
0..1 | IdentifierIknr | Optional Extensions Element URL: http://fhir.de/StructureDefinition/AbrechnendeIK | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | IdentifierIknr | An identifier intended for computation | ||||
| display |
Σ | 1..1 | string | Text alternative for the resource | ||||
| class |
0..* | BackboneElement | Additional coverage classifications | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| 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 | ||||
| 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 Slice: Unordered, Open by value:url | |||||
| 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 Slice: Unordered, Open by value:url | |||||
| 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 |
ΣC | 0..1 | Period | The effective period of the exception Constraints: per-1 | ||||
| subrogation |
0..1 | boolean | Reimbursement to insurer | |||||
| contract |
C | 0..* | Reference(Contract) | Contract details Constraints: ref-1 | ||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std. |
| Coverage.identifier:KrankenversichertenID.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:KrankenversichertenID.type | Base | required | Identifier Type Kvid DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.identifier:pseudo-Krankenversichertennummer.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:pseudo-Krankenversichertennummer.type | Base | extensible | Identifier Type DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | required | VersicherungsartDeBasisVS | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.subscriber.type | Base | extensible | ResourceType | 📦4.0.1 | FHIR Std. |
| Coverage.beneficiary.type | Base | extensible | ResourceType | 📦4.0.1 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📦4.0.1 | FHIR Std. |
| Coverage.payor.type | Base | extensible | ResourceType | 📦4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📦4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
| kvid-1 | warning | Coverage.identifier:KrankenversichertenID.value | Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen |
matches('^[A-Z][0-9]{9}$')
|
| kvid-2 | warning | Coverage.identifier:KrankenversichertenID.type | Die type Codes 'GKV' und 'PKV' haben den Status 'retired', daher sollen diese nicht mehr verwendet werden |
($this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='GKV') or $this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='PKV')).not()
|
| per-1 | error | Coverage.identifier:KrankenversichertenID.period, Coverage.identifier:pseudo-Krankenversichertennummer.period, Coverage.period, Coverage.costToBeneficiary.exception.period | If present, start SHALL have a lower value than end |
start.hasValue().not() or end.hasValue().not() or (start <= end)
|
| ref-1 | error | Coverage.identifier:KrankenversichertenID.assigner, Coverage.identifier:pseudo-Krankenversichertennummer.assigner, Coverage.subscriber, Coverage.beneficiary, Coverage.payor, Coverage.contract | SHALL have a contained resource if a local reference is provided |
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
|
This structure is derived from CoverageDeGkv
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Coverage |
0..* | CoverageDeGkv | Versicherungsdaten | |
| implicitRules |
?!Σ | 0..1 | uri | A set of rules under which this content was created |
| Slices for extension |
Content/Rules for all slices | |||
| extension:einlesedatumKarte |
0..1 | dateTime | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte | |
| extension:onlinepruefung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk | |
| extension:versionEgk |
0..1 | string | eGK Version (z.B. 5.2.0) URL: http://fhir.de/StructureDefinition/gkv/version-vsdm | |
| extension:generationEgk |
0..* | string | eGK Generation ( 1 | 1+ | 2 ) URL: http://fhir.de/StructureDefinition/gkv/generation-egk | |
| extension:versichertenart |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/versichertenart Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required) | |
| extension:kostenerstattung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung | |
| extension:wop |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/wop Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_ITA_WOP (required) | |
| extension:besonderePersonengruppe |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required) | |
| extension:dmpKennzeichen |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_DMP (required) | |
| extension:ruhenderLeistungsanspruch |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch | |
| extension:zuzahlungsstatus |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus | |
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url |
| Slices for identifier |
Σ | 1..* | Identifier | Primärer Identifier der Versicherung Slice: Unordered, Open by pattern:$this |
| identifier:KrankenversichertenID |
Σ | 0..1 | IdentifierKvid10 | An identifier intended for computation Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| period |
0..1 | Period | Time period when id is/was valid for use | |
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type |
ΣC | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Kvid DeBasis ValueSet (required): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Constraints: kvid-2 Fixed Value: (Complex) |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |
| display |
0..1 | string | Representation defined by the system | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| text |
0..1 | string | Plain text representation of the concept | |
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 |
| value |
ΣC | 1..1 | string | The value that is unique Constraints: kvid-1 Example General: 123456 |
| identifier:pseudo-Krankenversichertennummer |
Σ | 0..1 | IdentifierPseudoKvid | pseudonymisierte Krankenversichertennummer Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| period |
0..1 | Period | Time period when id is/was valid for use | |
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . |
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: ANON | |
| display |
0..1 | string | Representation defined by the system | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| text |
0..1 | string | Plain text representation of the concept | |
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/pseudo-kvid |
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 |
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. |
| type |
Σ | 1..1 | CodeableConcept | Versicherungsart Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt |
| Slices for coding |
Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this |
| coding:VersicherungsArtDeBasis |
Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis | |
| version |
0..1 | string | Version of the system - if relevant | |
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |
| display |
0..1 | string | Representation defined by the system | |
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |
| beneficiary |
ΣC | 1..1 | Reference(Patient) | Begünstigte Person Constraints: ref-1 |
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| identifier |
Σ | 0..1 | Identifier | Identifier der versicherten Person Required Pattern: At least the following |
| id |
0..1 | string | Unique id for inter-element referencing | |
| extension |
0..* | Extension | Additional content defined by implementations | |
| use |
0..1 | code | usual | official | temp | secondary | old (If known) | |
| type |
0..1 | CodeableConcept | Description of identifier | |
| system |
1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | |
| value |
0..1 | string | The value that is unique | |
| period |
0..1 | Period | Time period when id is/was valid for use | |
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |
| payor |
ΣC | 1..1 | Reference(Organization | Patient | RelatedPerson) | Versicherer Constraints: ref-1 |
| Slices for extension |
Content/Rules for all slices | |||
| extension:abrechnendeIK |
0..1 | IdentifierIknr | Optional Extensions Element URL: http://fhir.de/StructureDefinition/AbrechnendeIK | |
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL |
| display |
Σ | 1..1 | string | Text alternative for the resource |
| Documentation for this format | ||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.identifier:KrankenversichertenID.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:KrankenversichertenID.type | Base | required | Identifier Type Kvid DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.identifier:pseudo-Krankenversichertennummer.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:pseudo-Krankenversichertennummer.type | Base | extensible | Identifier Type DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | required | VersicherungsartDeBasisVS | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
| kvid-1 | warning | Coverage.identifier:KrankenversichertenID.value | Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen |
matches('^[A-Z][0-9]{9}$')
|
| kvid-2 | warning | Coverage.identifier:KrankenversichertenID.type | Die type Codes 'GKV' und 'PKV' haben den Status 'retired', daher sollen diese nicht mehr verwendet werden |
($this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='GKV') or $this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='PKV')).not()
|
| ref-1 | error | Coverage.beneficiary, Coverage.payor | SHALL have a contained resource if a local reference is provided |
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
|
Differential View
This structure is derived from CoverageDeGkv
| Name | Flags | Card. | Type | Description & Constraints Filter: |
|---|---|---|---|---|
| Coverage |
0..* | CoverageDeGkv | Versicherungsdaten | |
| Documentation for this format | ||||
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints Filter: | ||||
|---|---|---|---|---|---|---|---|---|
| Coverage |
0..* | CoverageDeGkv | Versicherungsdaten | |||||
| 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.
| |||||
| 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 for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:einlesedatumKarte |
0..1 | dateTime | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte | |||||
| extension:onlinepruefung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk | |||||
| extension:versionEgk |
0..1 | string | eGK Version (z.B. 5.2.0) URL: http://fhir.de/StructureDefinition/gkv/version-vsdm | |||||
| extension:generationEgk |
0..* | string | eGK Generation ( 1 | 1+ | 2 ) URL: http://fhir.de/StructureDefinition/gkv/generation-egk | |||||
| extension:versichertenart |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/versichertenart Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required) | |||||
| extension:kostenerstattung |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung | |||||
| extension:wop |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/wop Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_ITA_WOP (required) | |||||
| extension:besonderePersonengruppe |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required) | |||||
| extension:dmpKennzeichen |
0..1 | Coding | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen Binding: https://fhir.kbv.de/ValueSet/KBV_VS_SFHIR_KBV_DMP (required) | |||||
| extension:ruhenderLeistungsanspruch |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch | |||||
| extension:zuzahlungsstatus |
0..1 | (Complex) | Optional Extensions Element URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus | |||||
| modifierExtension |
?! | 0..* | Extension | Extensions that cannot be ignored Slice: Unordered, Open by value:url | ||||
| Slices for identifier |
Σ | 1..* | Identifier | Primärer Identifier der Versicherung Slice: Unordered, Open by pattern:$this | ||||
| identifier:KrankenversichertenID |
Σ | 0..1 | IdentifierKvid10 | An identifier intended for computation Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
ΣC | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type Kvid DeBasis ValueSet (required): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Constraints: kvid-2 Fixed Value: (Complex) | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/identifier-type-de-basis | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | ||||
| value |
ΣC | 1..1 | string | The value that is unique Constraints: kvid-1 Example General: 123456 | ||||
| period |
ΣC | 0..1 | Period | Time period when id is/was valid for use Constraints: per-1 | ||||
| assigner |
ΣC | 0..1 | Reference(Organization) | Organization that issued id (may be just text) Constraints: ref-1 | ||||
| identifier:pseudo-Krankenversichertennummer |
Σ | 0..1 | IdentifierPseudoKvid | pseudonymisierte Krankenversichertennummer Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use |
?!Σ | 0..1 | code | usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . | ||||
| type |
Σ | 1..1 | CodeableConcept | Description of identifier Binding: Identifier Type DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| coding |
1..* | Coding | Code defined by a terminology system Fixed Value: (Complex) | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v2-0203 | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: ANON | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
0..1 | string | Plain text representation of the concept | |||||
| system |
Σ | 1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/pseudo-kvid | ||||
| value |
Σ | 1..1 | string | The value that is unique Example General: 123456 | ||||
| period |
ΣC | 0..1 | Period | Time period when id is/was valid for use Constraints: per-1 | ||||
| assigner |
ΣC | 0..1 | Reference(Organization) | Organization that issued id (may be just text) Constraints: ref-1 | ||||
| status |
?!Σ | 1..1 | code | active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. | ||||
| type |
Σ | 1..1 | CodeableConcept | Versicherungsart Binding: VersicherungsartDeBasisVS (required): Art der Versicherung: Selbstzahler, gesetzliche/private Versicherung, Berufsgenossenschaft oder Sozialamt | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| Slices for coding |
Σ | 1..* | Coding | Code defined by a terminology system Slice: Unordered, Open by pattern:$this | ||||
| coding:VersicherungsArtDeBasis |
Σ | 1..1 | Coding | Code defined by a terminology system Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| system |
1..1 | uri | Identity of the terminology system Fixed Value: http://fhir.de/CodeSystem/versicherungsart-de-basis | |||||
| version |
0..1 | string | Version of the system - if relevant | |||||
| code |
1..1 | code | Symbol in syntax defined by the system Fixed Value: GKV | |||||
| display |
0..1 | string | Representation defined by the system | |||||
| userSelected |
0..1 | boolean | If this coding was chosen directly by the user | |||||
| text |
Σ | 0..1 | string | Plain text representation of the concept | ||||
| subscriber |
ΣC | 0..1 | Reference(Patient | RelatedPerson) | Hauptversicherte Person / Mitglied Constraints: ref-1 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | VersichertenID (10-stellig) des Hauptversicherten Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) | |||||
| type |
0..1 | CodeableConcept | Description of identifier | |||||
| system |
1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | |||||
| value |
0..1 | string | The value that is unique | |||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
| display |
Σ | 0..1 | string | Name des Hauptversicherten | ||||
| beneficiary |
ΣC | 1..1 | Reference(Patient) | Begünstigte Person Constraints: ref-1 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | Identifier | Identifier der versicherten Person Required Pattern: At least the following | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations | |||||
| use |
0..1 | code | usual | official | temp | secondary | old (If known) | |||||
| type |
0..1 | CodeableConcept | Description of identifier | |||||
| system |
1..1 | uri | The namespace for the identifier value Fixed Value: http://fhir.de/sid/gkv/kvid-10 | |||||
| value |
0..1 | string | The value that is unique | |||||
| period |
0..1 | Period | Time period when id is/was valid for use | |||||
| assigner |
0..1 | Reference(Organization) | Organization that issued id (may be just text) | |||||
| display |
Σ | 0..1 | string | Name der Versicherten Person | ||||
| dependent |
Σ | 0..1 | string | Dependent number | ||||
| relationship |
0..1 | CodeableConcept | Beneficiary relationship to the subscriber Binding: SubscriberRelationshipCodes (extensible): The relationship between the Subscriber and the Beneficiary (insured/covered party/patient). | |||||
| period |
ΣC | 0..1 | Period | Coverage start and end dates Constraints: per-1 | ||||
| payor |
ΣC | 1..1 | Reference(Organization | Patient | RelatedPerson) | Versicherer Constraints: ref-1 | ||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| extension:abrechnendeIK |
0..1 | IdentifierIknr | Optional Extensions Element URL: http://fhir.de/StructureDefinition/AbrechnendeIK | |||||
| reference |
ΣC | 0..1 | string | Literal reference, Relative, internal or absolute URL | ||||
| type |
Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model). | ||||
| identifier |
Σ | 0..1 | IdentifierIknr | An identifier intended for computation | ||||
| display |
Σ | 1..1 | string | Text alternative for the resource | ||||
| class |
0..* | BackboneElement | Additional coverage classifications | |||||
| id |
0..1 | string | Unique id for inter-element referencing | |||||
| extension |
0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| 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 | ||||
| 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 Slice: Unordered, Open by value:url | |||||
| 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 Slice: Unordered, Open by value:url | |||||
| 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 |
ΣC | 0..1 | Period | The effective period of the exception Constraints: per-1 | ||||
| subrogation |
0..1 | boolean | Reimbursement to insurer | |||||
| contract |
C | 0..* | Reference(Contract) | Contract details Constraints: ref-1 | ||||
| Documentation for this format | ||||||||
| Path | Status | Usage | ValueSet | Version | Source |
| Coverage.language | Base | preferred | Common Languages | 📦4.0.1 | FHIR Std. |
| Coverage.identifier:KrankenversichertenID.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:KrankenversichertenID.type | Base | required | Identifier Type Kvid DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.identifier:pseudo-Krankenversichertennummer.use | Base | required | IdentifierUse | 📍4.0.1 | FHIR Std. |
| Coverage.identifier:pseudo-Krankenversichertennummer.type | Base | extensible | Identifier Type DeBasis ValueSet | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.status | Base | required | Financial Resource Status Codes | 📍4.0.1 | FHIR Std. |
| Coverage.type | Base | required | VersicherungsartDeBasisVS | 📦1.6.0-ballot | de.basisprofil.r4 v1.6 |
| Coverage.subscriber.type | Base | extensible | ResourceType | 📦4.0.1 | FHIR Std. |
| Coverage.beneficiary.type | Base | extensible | ResourceType | 📦4.0.1 | FHIR Std. |
| Coverage.relationship | Base | extensible | SubscriberPolicyholder Relationship Codes | 📦4.0.1 | FHIR Std. |
| Coverage.payor.type | Base | extensible | ResourceType | 📦4.0.1 | FHIR Std. |
| Coverage.class.type | Base | extensible | Coverage Class Codes | 📦4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.type | Base | extensible | Coverage Copay Type Codes | 📦4.0.1 | FHIR Std. |
| Coverage.costToBeneficiary.exception.type | Base | example | Example Coverage Financial Exception Codes | 📦4.0.1 | FHIR Std. |
| Id | Grade | Path(s) | Description | Expression |
| 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()
|
| kvid-1 | warning | Coverage.identifier:KrankenversichertenID.value | Der unveränderliche Teil der KVID muss 10-stellig sein und mit einem Großbuchstaben anfangen |
matches('^[A-Z][0-9]{9}$')
|
| kvid-2 | warning | Coverage.identifier:KrankenversichertenID.type | Die type Codes 'GKV' und 'PKV' haben den Status 'retired', daher sollen diese nicht mehr verwendet werden |
($this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='GKV') or $this.coding.exists(system='http://fhir.de/CodeSystem/identifier-type-de-basis' and code='PKV')).not()
|
| per-1 | error | Coverage.identifier:KrankenversichertenID.period, Coverage.identifier:pseudo-Krankenversichertennummer.period, Coverage.period, Coverage.costToBeneficiary.exception.period | If present, start SHALL have a lower value than end |
start.hasValue().not() or end.hasValue().not() or (start <= end)
|
| ref-1 | error | Coverage.identifier:KrankenversichertenID.assigner, Coverage.identifier:pseudo-Krankenversichertennummer.assigner, Coverage.subscriber, Coverage.beneficiary, Coverage.payor, Coverage.contract | SHALL have a contained resource if a local reference is provided |
reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
|
This structure is derived from CoverageDeGkv
Other representations of profile: CSV, Excel, Schematron