Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource ksa-purpose-unique-code: Purpose code values must be unique. BV-00437: Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. BV-00538: CoverageEligibilityRequest.status SHALL use the fixed value 'active'.
id		1..1	id	Logical id of this artifact Max Length:64
meta		1..1	Meta	Metadata about the resource
profile		1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose		1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient		1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
Slices for serviced[x]		1..1	date, Period	Estimated date or dates of service Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created		1..1	DP_dateTime	Creation date
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
insurer		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
insurance	S	0..*	BackboneElement	Patient insurance information
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ksa-purpose-unique-code: Purpose code values must be unique. BV-00437: Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. BV-00538: CoverageEligibilityRequest.status SHALL use the fixed value 'active'.
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required) ele-1: All FHIR elements must have a @value or children
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required) ele-1: All FHIR elements must have a @value or children
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	DP_dateTime	Creation date ele-1: All FHIR elements must have a @value or children
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility ele-1: All FHIR elements must have a @value or children
insurance	S	0..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	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	CoverageEligibilityRequest	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	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource ksa-purpose-unique-code: Purpose code values must be unique. BV-00437: Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. BV-00538: CoverageEligibilityRequest.status SHALL use the fixed value 'active'.
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
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	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
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	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
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	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
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)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
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	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
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	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
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	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
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)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
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	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
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	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
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	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
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)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
supportingInfo		0..*	BackboneElement	Supporting information
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
sequence		1..1	positiveInt	Information instance identifier
information		1..1	Reference(Resource)	Data to be provided
appliesToAll		0..1	boolean	Applies to all items
insurance	S	0..*	BackboneElement	Patient insurance information
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
focal		0..1	boolean	Applicable coverage
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
item		0..*	BackboneElement	Item to be evaluated for eligibiity
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
supportingInfoSequence		0..*	positiveInt	Applicable exception or supporting information
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Perfoming practitioner
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
facility		0..1	Reference(Location | Organization)	Servicing facility
diagnosis		0..*	BackboneElement	Applicable diagnosis
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
diagnosis[x]		0..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
detail		0..*	Reference(Resource)	Product or service details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
CoverageEligibilityRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
CoverageEligibilityRequest.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose from the FHIR Standard
CoverageEligibilityRequest.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityRequest.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	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	CoverageEligibilityRequest	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	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Summary

Mandatory: 7 elements
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• DP_canonical (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-canonical)
• DP_Identifier_A (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Identifier-A)
• DP_CodeableConcept (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept)
• DP_code (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code)
• DP_Reference_1or2a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a)
• Nphies Patient (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient)
• DP_date (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-date)
• DP_Period_2 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Period-2)
• DP_dateTime (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-dateTime)
• Nphies Provider Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization)
• Nphies Insurer Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization)
• DP_Reference_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1)
• Nphies Location (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/location)
• Nphies Coverage (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage)

Extensions

This structure refers to these extensions:

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CoverageEligibilityRequest.serviced[x]

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource ksa-purpose-unique-code: Purpose code values must be unique. BV-00437: Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. BV-00538: CoverageEligibilityRequest.status SHALL use the fixed value 'active'.
id		1..1	id	Logical id of this artifact Max Length:64
meta		1..1	Meta	Metadata about the resource
profile		1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status		1..1	code	active | cancelled | draft | entered-in-error Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose		1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient		1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
Slices for serviced[x]		1..1	date, Period	Estimated date or dates of service Slice: Unordered, Open by type:$this
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created		1..1	DP_dateTime	Creation date
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
insurer		1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
identifier
type		1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
insurance	S	0..*	BackboneElement	Patient insurance information
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management ksa-purpose-unique-code: Purpose code values must be unique. BV-00437: Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. BV-00538: CoverageEligibilityRequest.status SHALL use the fixed value 'active'.
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource ele-1: All FHIR elements must have a @value or children
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to ele-1: All FHIR elements must have a @value or children
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. ele-1: All FHIR elements must have a @value or children Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required) ele-1: All FHIR elements must have a @value or children
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required) ele-1: All FHIR elements must have a @value or children
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this ele-1: All FHIR elements must have a @value or children
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service ele-1: All FHIR elements must have a @value or children
created	Σ	1..1	DP_dateTime	Creation date ele-1: All FHIR elements must have a @value or children
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer ele-1: All FHIR elements must have a @value or children
reference	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL ele-1: All FHIR elements must have a @value or children Max Length:250
identifier	SΣ	0..1	Identifier	Logical reference, when literal reference is not known ele-1: All FHIR elements must have a @value or children
use	?!Σ	0..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children
type	Σ	1..1	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required) ele-1: All FHIR elements must have a @value or children
system	Σ	1..1	DP_uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456 Max Length:50
display	Σ	0..1	string	Text alternative for the resource ele-1: All FHIR elements must have a @value or children Max Length:200
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility ele-1: All FHIR elements must have a @value or children
insurance	S	0..*	BackboneElement	Patient insurance information ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	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	CoverageEligibilityRequest	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	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Name	Flags	Card.	Type	Description & Constraints
CoverageEligibilityRequest	C	0..*	CoverageEligibilityRequest	CoverageEligibilityRequest resource ksa-purpose-unique-code: Purpose code values must be unique. BV-00437: Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. BV-00538: CoverageEligibilityRequest.status SHALL use the fixed value 'active'.
id	Σ	1..1	id	Logical id of this artifact Max Length:64
meta	Σ	1..1	Meta	Metadata about the resource
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	Σ	0..1	id	Version specific identifier
lastUpdated	Σ	0..1	instant	When the resource version last changed
source	Σ	0..1	uri	Identifies where the resource comes from
profile	Σ	1..*	DP_canonical(StructureDefinition)	Profiles this resource claims to conform to
security	Σ	0..*	Coding	Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
tag	Σ	0..*	Coding	Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
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. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:newborn	S	0..1	boolean	Newborn URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
extension:transfer	S	0..1	boolean	Transfer URL: http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		1..1	DP_Identifier_A	Business Identifier for coverage eligiblity request
status	?!Σ	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance. Required Pattern: active
priority		1..1	DP_CodeableConcept	Desired processing priority Binding: ProcessPriorityCodes (required)
purpose	Σ	1..*	DP_code	auth-requirements | benefits | discovery | validation Binding: EligibilityRequestPurpose (required)
patient	Σ	1..1	DP_Reference_1or2a(Nphies Patient)	Intended recipient of products and services
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	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
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	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
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	DP_CodeableConcept	Description of identifier Binding: Patient Identifier Type (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
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)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
Slices for serviced[x]		1..1		Estimated date or dates of service Slice: Unordered, Closed by type:$this
servicedDate			date
servicedPeriod			Period
serviced[x]:servicedDate	S	0..1	DP_date	Estimated date or dates of service
serviced[x]:servicedPeriod	S	0..1	DP_Period_2	Estimated date or dates of service
created	Σ	1..1	DP_dateTime	Creation date
enterer		0..1	Reference(Practitioner | PractitionerRole)	Author
provider		1..1	DP_Reference_1or2a(Nphies Provider Organization)	Party responsible for the request
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	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
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	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
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	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
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)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
insurer	Σ	1..1	DP_Reference_1or2a(Nphies Insurer Organization)	Coverage issuer
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	SΣC	0..1	string	Literal reference, Relative, internal or absolute URL Max Length:250
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	SΣ	0..1	Identifier	Logical reference, when literal reference is not known
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	DP_CodeableConcept	Description of identifier Binding: Identifier Type Codes (required)
system	Σ	1..1	DP_uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456 Max Length:50
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)
display	Σ	0..1	string	Text alternative for the resource Max Length:200
facility	S	0..1	DP_Reference_1(Nphies Location)	Servicing facility
supportingInfo		0..*	BackboneElement	Supporting information
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
sequence		1..1	positiveInt	Information instance identifier
information		1..1	Reference(Resource)	Data to be provided
appliesToAll		0..1	boolean	Applies to all items
insurance	S	0..*	BackboneElement	Patient insurance information
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
focal		0..1	boolean	Applicable coverage
coverage		1..1	DP_Reference_1(Nphies Coverage)	Insurance information
businessArrangement		0..1	string	Additional provider contract number
item		0..*	BackboneElement	Item to be evaluated for eligibiity
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
supportingInfoSequence		0..*	positiveInt	Applicable exception or supporting information
category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral, medical, vision etc.
productOrService		0..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
provider		0..1	Reference(Practitioner | PractitionerRole)	Perfoming practitioner
quantity		0..1	SimpleQuantity	Count of products or services
unitPrice		0..1	Money	Fee, charge or cost per item
facility		0..1	Reference(Location | Organization)	Servicing facility
diagnosis		0..*	BackboneElement	Applicable diagnosis
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
diagnosis[x]		0..1		Nature of illness or problem Binding: ICD-10Codes (example): ICD10 Diagnostic codes.
diagnosisCodeableConcept			CodeableConcept
diagnosisReference			Reference(Condition)
detail		0..*	Reference(Resource)	Product or service details
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CoverageEligibilityRequest.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
CoverageEligibilityRequest.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
CoverageEligibilityRequest.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CoverageEligibilityRequest.status	required	Pattern: active http://hl7.org/fhir/ValueSet/fm-status|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.priority	required	ProcessPriorityCodes http://hl7.org/fhir/ValueSet/process-priority from the FHIR Standard
CoverageEligibilityRequest.purpose	required	EligibilityRequestPurpose http://hl7.org/fhir/ValueSet/eligibilityrequest-purpose from the FHIR Standard
CoverageEligibilityRequest.patient.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.patient.identifier.type	required	PatientIdentifierType http://nphies.sa/terminology/ValueSet/patient-identifier-type from this IG
CoverageEligibilityRequest.provider.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityRequest.provider.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.provider.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.insurer.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.use	required	IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
CoverageEligibilityRequest.insurer.identifier.type	required	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
CoverageEligibilityRequest.item.category	example	BenefitCategoryCodes http://hl7.org/fhir/ValueSet/ex-benefitcategory from the FHIR Standard
CoverageEligibilityRequest.item.productOrService	example	USCLSCodes http://hl7.org/fhir/ValueSet/service-uscls from the FHIR Standard
CoverageEligibilityRequest.item.modifier	example	ModifierTypeCodes http://hl7.org/fhir/ValueSet/claim-modifiers from the FHIR Standard
CoverageEligibilityRequest.item.diagnosis.diagnosis[x]	example	ICD-10Codes http://hl7.org/fhir/ValueSet/icd-10 from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
BV-00437	error	CoverageEligibilityRequest	Either CoverageEligibilityRequest.servicedDate or CoverageEligibilityRequest.servicedPeriod SHALL exist. : serviced.ofType(date).exists() xor serviced.ofType(Period).exists()
BV-00538	error	CoverageEligibilityRequest	CoverageEligibilityRequest.status SHALL use the fixed value 'active'. : status.exists() implies status = 'active'
dom-2	error	CoverageEligibilityRequest	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	CoverageEligibilityRequest	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	CoverageEligibilityRequest	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	CoverageEligibilityRequest	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	CoverageEligibilityRequest	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()
ksa-purpose-unique-code	error	CoverageEligibilityRequest	Purpose code values must be unique. : purpose.exists() implies purpose.isDistinct()

Summary

Mandatory: 7 elements
Must-Support: 6 elements

Structures

This structure refers to these other structures:

• DP_canonical (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-canonical)
• DP_Identifier_A (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Identifier-A)
• DP_CodeableConcept (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-CodeableConcept)
• DP_code (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-code)
• DP_Reference_1or2a (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1or2a)
• Nphies Patient (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient)
• DP_date (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-date)
• DP_Period_2 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Period-2)
• DP_dateTime (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-dateTime)
• Nphies Provider Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization)
• Nphies Insurer Organization (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization)
• DP_Reference_1 (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/DP-Reference-1)
• Nphies Location (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/location)
• Nphies Coverage (http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage)

Extensions

This structure refers to these extensions:

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-newborn
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-transfer

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of CoverageEligibilityRequest.serviced[x]