German Practice Management FHIR Profiles (R4)
0.90.0 - STU1 Germany

German Practice Management FHIR Profiles (R4) - Local Development build (v0.90.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Resource Profile: FPDE Coverage GKV

Official URL: https://fhir.cognovis.de/praxis/StructureDefinition/fpde-coverage-gkv Version: 0.90.0
Active as of 2026-07-29 Computable Name: FPDECoverageGKV
Other Identifiers: OID:2.16.840.1.113883.3.7985.42.170

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

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeGkv(1.5.4) 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 N 0..1 dateTime Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte
.... extension:onlinepruefung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk
.... extension:versionEgk N 0..1 string eGK Version (z.B. 5.2.0)
URL: http://fhir.de/StructureDefinition/gkv/version-vsdm
.... extension:generationEgk N 0..* string eGK Generation ( 1 | 1+ | 2 )
URL: http://fhir.de/StructureDefinition/gkv/generation-egk
.... extension:versichertenart N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/versichertenart
Binding: KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required)
.... extension:kostenerstattung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung
.... extension:wop N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/wop
Binding: KBV_VS_SFHIR_ITA_WOP (required)
.... extension:besonderePersonengruppe N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe
Binding: KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required)
.... extension:dmpKennzeichen N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen
Binding: KBV_VS_SFHIR_KBV_DMP (required)
.... extension:ruhenderLeistungsanspruch N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch
.... extension:zuzahlungsstatus N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus
.... extension:ktAbrechnungsbereich S 0..1 Coding KT-Abrechnungsbereich (Schein.KT-Abrechnungsbereich)
URL: https://fhir.cognovis.de/praxis/StructureDefinition/coverage-kt-abrechnungsbereich
Binding: KBV_VS_SFHIR_KTS_KTABRECHNUNGSBEREICH (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... identifier:KrankenversichertenID ΣN 0..1 IdentifierKvid10(1.5.4) 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 DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
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://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: KVZ10
....... 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 ΣN 0..1 IdentifierPseudoKvid(1.5.4) 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 Σ 1..1 Reference(Patient) Begünstigte Person
.... 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 Σ 1..1 Reference(Organization | Patient | RelatedPerson) Versicherer
.... Slices for extension Content/Rules for all slices
..... extension:abrechnendeIK N 0..1 IdentifierIknr(1.5.4) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/AbrechnendeIK
.... display Σ 1..1 string Text alternative for the resource

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier:KrankenversichertenID.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:KrankenversichertenID.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.identifier:pseudo-Krankenversichertennummer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:pseudo-Krankenversichertennummer.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5

Constraints

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()

This structure is derived from CoverageDeGkv

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeGkv(1.5.4) Versicherungsdaten
... Slices for extension Content/Rules for all slices
.... extension:ktAbrechnungsbereich S 0..1 Coding KT-Abrechnungsbereich (Schein.KT-Abrechnungsbereich)
URL: https://fhir.cognovis.de/praxis/StructureDefinition/coverage-kt-abrechnungsbereich
Binding: KBV_VS_SFHIR_KTS_KTABRECHNUNGSBEREICH (required)

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeGkv(1.5.4) 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
... 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 N 0..1 dateTime Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte
.... extension:onlinepruefung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk
.... extension:versionEgk N 0..1 string eGK Version (z.B. 5.2.0)
URL: http://fhir.de/StructureDefinition/gkv/version-vsdm
.... extension:generationEgk N 0..* string eGK Generation ( 1 | 1+ | 2 )
URL: http://fhir.de/StructureDefinition/gkv/generation-egk
.... extension:versichertenart N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/versichertenart
Binding: KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required)
.... extension:kostenerstattung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung
.... extension:wop N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/wop
Binding: KBV_VS_SFHIR_ITA_WOP (required)
.... extension:besonderePersonengruppe N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe
Binding: KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required)
.... extension:dmpKennzeichen N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen
Binding: KBV_VS_SFHIR_KBV_DMP (required)
.... extension:ruhenderLeistungsanspruch N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch
.... extension:zuzahlungsstatus N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus
.... extension:ktAbrechnungsbereich S 0..1 Coding KT-Abrechnungsbereich (Schein.KT-Abrechnungsbereich)
URL: https://fhir.cognovis.de/praxis/StructureDefinition/coverage-kt-abrechnungsbereich
Binding: KBV_VS_SFHIR_KTS_KTABRECHNUNGSBEREICH (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier Primärer Identifier der Versicherung
Slice: Unordered, Open by pattern:$this
.... identifier:KrankenversichertenID ΣN 0..1 IdentifierKvid10(1.5.4) 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 DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
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://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: KVZ10
....... 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 Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:pseudo-Krankenversichertennummer ΣN 0..1 IdentifierPseudoKvid(1.5.4) 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 Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... 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 Σ 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
.... 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 Σ 1..1 Reference(Patient) Begünstigte Person
.... 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 Σ 0..1 Period Coverage start and end dates
... payor Σ 1..1 Reference(Organization | Patient | RelatedPerson) Versicherer
.... 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 N 0..1 IdentifierIknr(1.5.4) 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(1.5.4) 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
.... 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
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

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 extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.identifier:pseudo-Krankenversichertennummer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:pseudo-Krankenversichertennummer.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5
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.

Constraints

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()

This structure is derived from CoverageDeGkv

Summary

Must-Support: 1 element

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeGkv(1.5.4) 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 N 0..1 dateTime Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte
.... extension:onlinepruefung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk
.... extension:versionEgk N 0..1 string eGK Version (z.B. 5.2.0)
URL: http://fhir.de/StructureDefinition/gkv/version-vsdm
.... extension:generationEgk N 0..* string eGK Generation ( 1 | 1+ | 2 )
URL: http://fhir.de/StructureDefinition/gkv/generation-egk
.... extension:versichertenart N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/versichertenart
Binding: KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required)
.... extension:kostenerstattung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung
.... extension:wop N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/wop
Binding: KBV_VS_SFHIR_ITA_WOP (required)
.... extension:besonderePersonengruppe N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe
Binding: KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required)
.... extension:dmpKennzeichen N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen
Binding: KBV_VS_SFHIR_KBV_DMP (required)
.... extension:ruhenderLeistungsanspruch N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch
.... extension:zuzahlungsstatus N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus
.... extension:ktAbrechnungsbereich S 0..1 Coding KT-Abrechnungsbereich (Schein.KT-Abrechnungsbereich)
URL: https://fhir.cognovis.de/praxis/StructureDefinition/coverage-kt-abrechnungsbereich
Binding: KBV_VS_SFHIR_KTS_KTABRECHNUNGSBEREICH (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
.... identifier:KrankenversichertenID ΣN 0..1 IdentifierKvid10(1.5.4) 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 DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
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://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: KVZ10
....... 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 ΣN 0..1 IdentifierPseudoKvid(1.5.4) 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 Σ 1..1 Reference(Patient) Begünstigte Person
.... 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 Σ 1..1 Reference(Organization | Patient | RelatedPerson) Versicherer
.... Slices for extension Content/Rules for all slices
..... extension:abrechnendeIK N 0..1 IdentifierIknr(1.5.4) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/AbrechnendeIK
.... display Σ 1..1 string Text alternative for the resource

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Coverage.identifier:KrankenversichertenID.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:KrankenversichertenID.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.identifier:pseudo-Krankenversichertennummer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:pseudo-Krankenversichertennummer.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5

Constraints

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()

Differential View

This structure is derived from CoverageDeGkv

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeGkv(1.5.4) Versicherungsdaten
... Slices for extension Content/Rules for all slices
.... extension:ktAbrechnungsbereich S 0..1 Coding KT-Abrechnungsbereich (Schein.KT-Abrechnungsbereich)
URL: https://fhir.cognovis.de/praxis/StructureDefinition/coverage-kt-abrechnungsbereich
Binding: KBV_VS_SFHIR_KTS_KTABRECHNUNGSBEREICH (required)

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Coverage 0..* CoverageDeGkv(1.5.4) 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
... 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 N 0..1 dateTime Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/einlesedatum-karte
.... extension:onlinepruefung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/onlinepruefung-egk
.... extension:versionEgk N 0..1 string eGK Version (z.B. 5.2.0)
URL: http://fhir.de/StructureDefinition/gkv/version-vsdm
.... extension:generationEgk N 0..* string eGK Generation ( 1 | 1+ | 2 )
URL: http://fhir.de/StructureDefinition/gkv/generation-egk
.... extension:versichertenart N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/versichertenart
Binding: KBV_VS_SFHIR_KBV_VERSICHERTENSTATUS (required)
.... extension:kostenerstattung N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/kostenerstattung
.... extension:wop N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/wop
Binding: KBV_VS_SFHIR_ITA_WOP (required)
.... extension:besonderePersonengruppe N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/besondere-personengruppe
Binding: KBV_VS_SFHIR_KBV_PERSONENGRUPPE (required)
.... extension:dmpKennzeichen N 0..1 Coding Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/dmp-kennzeichen
Binding: KBV_VS_SFHIR_KBV_DMP (required)
.... extension:ruhenderLeistungsanspruch N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/ruhender-leistungsanspruch
.... extension:zuzahlungsstatus N 0..1 (Complex) Optional Extensions Element
URL: http://fhir.de/StructureDefinition/gkv/zuzahlungsstatus
.... extension:ktAbrechnungsbereich S 0..1 Coding KT-Abrechnungsbereich (Schein.KT-Abrechnungsbereich)
URL: https://fhir.cognovis.de/praxis/StructureDefinition/coverage-kt-abrechnungsbereich
Binding: KBV_VS_SFHIR_KTS_KTABRECHNUNGSBEREICH (required)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... Slices for identifier Σ 1..* Identifier Primärer Identifier der Versicherung
Slice: Unordered, Open by pattern:$this
.... identifier:KrankenversichertenID ΣN 0..1 IdentifierKvid10(1.5.4) 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 DeBasis ValueSet (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Constraints: kvid-2
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://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: KVZ10
....... 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 Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... identifier:pseudo-Krankenversichertennummer ΣN 0..1 IdentifierPseudoKvid(1.5.4) 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 Σ 0..1 Period Time period when id is/was valid for use
..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... 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 Σ 0..1 Reference(Patient | RelatedPerson) Hauptversicherte Person / Mitglied
.... 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 Σ 1..1 Reference(Patient) Begünstigte Person
.... 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 Σ 0..1 Period Coverage start and end dates
... payor Σ 1..1 Reference(Organization | Patient | RelatedPerson) Versicherer
.... 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 N 0..1 IdentifierIknr(1.5.4) 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(1.5.4) 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
.... 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
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type Σ 0..1 CodeableConcept Cost category
Binding: CoverageCopayTypeCodes (extensible): The types of services to which patient copayments are specified.
.... value[x] Σ 1..1 The amount or percentage due from the beneficiary
..... valueQuantity Quantity(SimpleQuantity)
..... valueMoney Money
.... exception 0..* BackboneElement Exceptions for patient payments
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type Σ 1..1 CodeableConcept Exception category
Binding: ExampleCoverageFinancialExceptionCodes (example): The types of exceptions from the part or full value of financial obligations such as copays.
..... period Σ 0..1 Period The effective period of the exception
... subrogation 0..1 boolean Reimbursement to insurer
... contract 0..* Reference(Contract) Contract details

doco Documentation for this format

Terminology Bindings

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 extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.identifier:pseudo-Krankenversichertennummer.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Coverage.identifier:pseudo-Krankenversichertennummer.​type Base extensible Identifier Type DeBasis ValueSet 📦1.5.4 de.basisprofil.r4 v1.5
Coverage.status Base required Financial Resource Status Codes 📍4.0.1 FHIR Std.
Coverage.type Base required VersicherungsartDeBasisVS 📦1.5.4 de.basisprofil.r4 v1.5
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.

Constraints

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()

This structure is derived from CoverageDeGkv

Summary

Must-Support: 1 element

Extensions

This structure refers to these extensions:

 

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