231 lines
6.5 KiB
JSON
231 lines
6.5 KiB
JSON
{
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"resourceType" : "Coverage",
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"id" : "",
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"identifier" : [{
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"use" : "",
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"type": {
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"coding" : [{
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"system" : "http://terminology.hl7.org/CodeSystem/organization-type",
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"version" : "",
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"code" : "pay",
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"display" : "Payer",
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"userSelected" : true
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}],
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"text" : ""
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},
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"system" : "",
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"value" : "",
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"period" : {"start" : "", "end" : ""},
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"assigner": {
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"reference" : "",
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"display" : ""
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}
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}],
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"status" : "active",
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"kind" : "",
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"paymentBy" : [{
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"party" : {
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"reference" : "",
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"display" : ""
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},
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"responsibility": ""
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}],
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"type" : {
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"coding": [{
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"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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"version" : "",
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"code" : "EHCPOL",
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"display" : "extended healthcare",
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"userSelected" : ""
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}],
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"text": "BPJS Kesehatan Coverage"
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},
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"policyHolder" : {
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"reference" : "",
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"display" : ""
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},
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"subscriber": {
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"reference" : "Patient/12345",
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"display" : "Budi Santoso"
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},
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"subscriberId" : [{
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"coding": [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "",
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"userSelected" : ""
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}],
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"text": ""
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}],
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"beneficiary": {
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"reference" : "Patient/12345",
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"display" : "Budi Santoso"
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},
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"dependent" : "",
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"relationship" : {
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"coding": [{
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"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
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"version" : "",
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"code" : "self",
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"display" : "Self",
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"userSelected" : ""
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}],
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"text" : ""
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},
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"period" : {"start": "2020-01-01","end": "9999-12-31"},
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"insurer" : {
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"reference" : "",
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"display" : ""
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},
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"class": [{
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"type" : {
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"coding": [{
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"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
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"version" : "",
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"code" : "group",
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"display" : "Group",
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"userSelected" : ""
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}],
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"text" : ""
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},
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"value" : {
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"use" : "",
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"type": {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "PPU",
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"display" : "Pekerja Penerima Upah",
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"userSelected" : false
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}],
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"text" : "Pekerja Penerima Upah"
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},
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"system" : "",
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"value" : "",
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"period" : {"start" : "", "end" : ""},
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"assigner": {
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"reference" : "",
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"display" : ""
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}
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},
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"name" : "Pekerja Penerima Upah"
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},
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{
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"type": {
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"coding": [{
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"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
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"version" : "",
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"code" : "plan",
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"display" : "Plan",
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"userSelected" : ""
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}],
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"text" : ""
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},
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"value": {
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"use" : "",
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"type": {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "Kelas 2",
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"userSelected" : true
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}],
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"text" : ""
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},
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"system" : "",
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"value" : "",
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"period" : {"start" : "", "end" : ""},
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"assigner": {
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"reference" : "",
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"display" : ""
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}
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},
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"name" : ""
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}],
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"order" : 0,
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"network" : "RSUD Dr. Saiful Anwar",
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"costToBeneficiary" : [{
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"type" : {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "Kelas 2",
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"userSelected" : true
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}],
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"text" : ""
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},
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"category" : {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "Kelas 2",
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"userSelected" : true
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}],
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"text" : ""
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},
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"network" : {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "Kelas 2",
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"userSelected" : true
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}],
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"text" : ""
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},
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"unit" : {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "Kelas 2",
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"userSelected" : true
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}],
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"text" : ""
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},
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"term" : {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "Kelas 2",
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"userSelected" : true
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}],
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"text" : ""
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}
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}],
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"value" : {
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"valueQuantity" : "",
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"valueMoney" : {
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"value" : 0,
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"currency" : ""
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}
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},
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"exception" : [{
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"type" : {
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"coding" : [{
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"system" : "",
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"version" : "",
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"code" : "",
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"display" : "Kelas 2",
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"userSelected" : true
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}],
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"text" : ""
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},
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"period" : {"start" : "", "end" : ""}
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}],
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"subrogation" : 0,
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"contact" : {
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"reference" : "",
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"display" : ""
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},
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"insurancePlan" : {
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"reference" : "",
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"display" : ""
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}
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}
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