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: PAS Coverage Example - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="8"/>
  <meta>
    <lastUpdated value="2026-01-07T01:21:11.866-06:00"/>
    <profile
             value="https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-pas-coverage-profile"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Coverage 8</b></p><a name="8"> </a><a name="hc8"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2026-01-07 01:21:11-0600</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-athena-pas-coverage-profile.html">PAS Coverage</a></p></div><p><b>org/fhir/us/davinci-pas/StructureDefinition/extension-coverageKind</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}">health insurance plan policy</span></p><p><b>identifier</b>: Member Number/665993433, National Insurance Payor Identifier (Payor)/Unknown, National Insurance Payor Identifier (Payor)/12345678, National Insurance Payor Identifier (Payor)/1101</p><p><b>status</b>: Active</p><p><b>policyHolder</b>: <a href="Patient/1442678380400620">Patient/1442678380400620</a></p><p><b>subscriber</b>: <a href="Patient/1442678380400620">Patient/1442678380400620</a></p><p><b>subscriberId</b>: 665993433</p><p><b>beneficiary</b>: <a href="Patient/1442678380400620">Patient/1442678380400620</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship other}, {https://valueset.x12.org/x217/005010/request/2000D/INS/1/02/00/1069 G8}">other</span></p><p><b>period</b>: 2007-01-31 00:00:00-0600 --&gt; 2008-01-30 00:00:00-0600</p><p><b>payor</b>: <a href="Organization/IC-5">Organization/IC-5</a></p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-coverageKind">
    <valueCodeableConcept>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="HIP"/>
        <display value="health insurance plan policy"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
        <display value="Member Number"/>
      </coding>
      <text value="Member Number"/>
    </type>
    <value value="665993433"/>
  </identifier>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="NIIP"/>
        <display value="National Insurance Payor Identifier (Payor)"/>
      </coding>
      <text value="National Insurance Payor Identifier (Payor)"/>
    </type>
    <value value="Unknown"/>
  </identifier>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="NIIP"/>
        <display value="National Insurance Payor Identifier (Payor)"/>
      </coding>
      <text value="National Insurance Payor Identifier (Payor)"/>
    </type>
    <value value="12345678"/>
  </identifier>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="NIIP"/>
        <display value="National Insurance Payor Identifier (Payor)"/>
      </coding>
      <text value="National Insurance Payor Identifier (Payor)"/>
    </type>
    <value value="1101"/>
  </identifier>
  <status value="active"/>
  <policyHolder>
    <reference value="Patient/1442678380400620"/>
  </policyHolder>
  <subscriber>
    <reference value="Patient/1442678380400620"/>
  </subscriber>
  <subscriberId value="665993433"/>
  <beneficiary>
    <reference value="Patient/1442678380400620"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="other"/>
      <display value="other"/>
    </coding>
    <coding>
      <system
              value="https://valueset.x12.org/x217/005010/request/2000D/INS/1/02/00/1069"/>
      <code value="G8"/>
      <display value="Other Relationship"/>
    </coding>
    <text value="other"/>
  </relationship>
  <period>
    <start value="2007-01-31T00:00:00-06:00"/>
    <end value="2008-01-30T00:00:00-06:00"/>
  </period>
  <payor>
    <reference value="Organization/IC-5"/>
  </payor>
</Coverage>