This page is part of the T17 IG (v1.0.0: draft-1 Draft) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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: t17-response - JSON Representation

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{
  "resourceType" : "CoverageEligibilityResponse",
  "id" : "t17-response",
  "meta" : {
    "profile" : [
      🔗 "http://ig.fhir-il-community.org/T17/StructureDefinition/t17-response"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">המענה לבקשה להתחייבות - קוד שירות אחד מאושר ושלושה נענו בסירוב</div>"
  },
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:uuid:b3b72e7b-5390-43a0-9499-af300f6a8d7b"
    }
  ],
  "status" : "active",
  "purpose" : [
    "validation"
  ],
  "patient" : {
    "identifier" : {
      "system" : "http://fhir.leumit.co.il/identifier/magnetic-card",
      "value" : "1-123456-123456-789"
    }
  },
  "created" : "2023-07-02T13:44:58.429Z",
  "requestor" : {
    "type" : "Organization",
    "identifier" : {
      "system" : "http://fhir.health.gov.il/identifier/legal-entity",
      "value" : "500106919"
    },
    "display" : "בי\"ח איכילוב"
  },
  "request" : {
    "identifier" : {
      "system" : "http://fhir.tlvmc.gov.il/identifier/preauth-req-no",
      "value" : "3772"
    }
  },
  "outcome" : "complete",
  "disposition" : "הבקשה להתחייבות אושרה חלקית",
  "insurer" : {
    "identifier" : {
      "system" : "http://fhir.health.gov.il/identifier/legal-entity",
      "value" : "580039899"
    },
    "display" : "לאומית"
  },
  "insurance" : [
    {
      "coverage" : {
        "reference" : "Coverage/3819",
        "identifier" : {
          "system" : "http://fhir.leumit.co.il/identifier/obligation-num",
          "value" : "1-1222223"
        }
      },
      "benefitPeriod" : {
        "start" : "2023-05-25",
        "end" : "2023-08-25"
      },
      "item" : [
        {
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://fhir.health.gov.il/cs/medical-service-moh",
                "code" : "L9258",
                "display" : "בדיקת רופא ילדים במרפאה"
              }
            ]
          },
          "excluded" : false,
          "name" : "בדיקת רופא - התמחות בכליות",
          "description" : "בדיקת רופא ילדים עם התמחות לכליות",
          "benefit" : [
            {
              "type" : {
                "text" : "benefit"
              },
              "allowedUnsignedInt" : 3,
              "usedUnsignedInt" : 1
            }
          ]
        },
        {
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://fhir.health.gov.il/cs/medical-service-moh",
                "code" : "L9261",
                "display" : "תיאור קוד שירות L9261"
              }
            ]
          },
          "modifier" : [
            {
              "coding" : [
                {
                  "system" : "http://fhir.health.gov.il/cs/moh-form17-issue-code",
                  "code" : "service-not-covered",
                  "display" : "השירות אינו בסל"
                }
              ]
            }
          ],
          "excluded" : true,
          "name" : "בדיקת רופא - התמחות כללית",
          "description" : "התמחות כללית"
        },
        {
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://fhir.health.gov.il/cs/medical-service-moh",
                "code" : "L9266",
                "display" : "תיאור קוד שירות L9266"
              }
            ]
          },
          "modifier" : [
            {
              "coding" : [
                {
                  "system" : "http://fhir.health.gov.il/cs/moh-form17-issue-code",
                  "code" : "service-not-covered",
                  "display" : "השירות אינו בסל"
                }
              ]
            }
          ],
          "excluded" : true,
          "name" : "בדיקת רופא - התמחות x מסוג",
          "description" : "התמחות x"
        },
        {
          "productOrService" : {
            "coding" : [
              {
                "system" : "http://fhir.health.gov.il/cs/medical-service-moh",
                "code" : "99242",
                "display" : "תיאור קוד שירות 99242"
              }
            ]
          },
          "modifier" : [
            {
              "coding" : [
                {
                  "system" : "http://fhir.health.gov.il/cs/moh-form17-issue-code",
                  "code" : "service-not-covered",
                  "display" : "השירות אינו בסל"
                }
              ]
            }
          ],
          "excluded" : true,
          "name" : "בדיקת רופא - התמחות y מסוג",
          "description" : "התמחות y"
        }
      ]
    }
  ]
}