CMSgov/dpc-app

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        <lastUpdated value="2021-06-08T01:55:08.681+00:00" />
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    <link>
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            <Coverage xmlns="http://hl7.org/fhir">
                <id value="part-a--20000000001809" />
                <meta>
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                    <profile value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/ms_cd">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ms_cd" />
                        <code value="10" />
                        <display value="Aged without end-stage renal disease (ESRD)" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/orec">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/orec" />
                        <code value="0" />
                        <display value="Old age and survivor’s insurance (OASI)" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/crec">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/crec" />
                        <code value="0" />
                        <display value="Old age and survivor’s insurance (OASI)" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/esrd_ind">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/esrd_ind" />
                        <code value="0" />
                        <display value="the beneficiary does not have ESRD" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/a_trm_cd">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/a_trm_cd" />
                        <code value="0" />
                        <display value="Not Terminated" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rfrnc_yr">
                    <valueDate value="0003" />
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_01" />
                        <code value="AA" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_02" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_03">
                    <valueCoding>
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                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_04" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_05" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_06" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_07" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_08" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_09" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_10" />
                        <code value="AA" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_11" />
                        <code value="AA" />
                    </valueCoding>
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                <extension url="https://bluebutton.cms.gov/resources/variables/dual_12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_12" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin01" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin02" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin03" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin04" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin05" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin06" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin07" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin08" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin09" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin10" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin11" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin12" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <status value="active" />
                <type>
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                        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode" />
                        <code value="SUBSIDIZ" />
                    </coding>
                </type>
                <subscriberId value="1SQ3F00AA00" />
                <beneficiary>
                    <reference value="Patient/-20000000001809" />
                </beneficiary>
                <relationship>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/subscriber-relationship" />
                        <code value="self" />
                        <display value="Self" />
                    </coding>
                </relationship>
                <period>
                    <start value="1983-03-24" />
                </period>
                <payor>
                    <identifier>
                        <value value="Centers for Medicare and Medicaid Services" />
                    </identifier>
                </payor>
                <class>
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                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="group" />
                            <display value="Group" />
                        </coding>
                    </type>
                    <value value="Medicare" />
                </class>
                <class>
                    <type>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="plan" />
                            <display value="Plan" />
                        </coding>
                    </type>
                    <value value="Part A" />
                </class>
                <contract id="contract1" />
                <contract>
                    <reference value="Coverage/part-a-contract1" />
                </contract>
            </Coverage>
        </resource>
    </entry>
    <entry>
        <resource>
            <Coverage xmlns="http://hl7.org/fhir">
                <id value="part-b--20000000001809" />
                <meta>
                    <lastUpdated value="2021-06-08T01:50:57.614+00:00" />
                    <profile value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage" />
                </meta>
                <extension url="https://bluebutton.cms.gov/resources/variables/ms_cd">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ms_cd" />
                        <code value="10" />
                        <display value="Aged without end-stage renal disease (ESRD)" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/b_trm_cd">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/b_trm_cd" />
                        <code value="0" />
                        <display value="Not Terminated" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rfrnc_yr">
                    <valueDate value="0003" />
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_01" />
                        <code value="AA" />
                    </valueCoding>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_02" />
                        <code value="AA" />
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                        <system value="https://bluebutton.cms.gov/resources/variables/dual_03" />
                        <code value="AA" />
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                        <code value="AA" />
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                        <code value="AA" />
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                        <code value="AA" />
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                        <code value="AA" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_08" />
                        <code value="AA" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_09" />
                        <code value="AA" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_10" />
                        <code value="AA" />
                    </valueCoding>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_11" />
                        <code value="AA" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_12" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin01" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin02" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin03" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin04" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin05" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
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                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin07" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/buyin08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin08" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin09" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin10" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
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                <extension url="https://bluebutton.cms.gov/resources/variables/buyin11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin11" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/buyin12" />
                        <code value="C" />
                        <display value="Part A and Part B state buy-in" />
                    </valueCoding>
                </extension>
                <status value="active" />
                <type>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode" />
                        <code value="SUBSIDIZ" />
                    </coding>
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                <subscriberId value="1SQ3F00AA00" />
                <beneficiary>
                    <reference value="Patient/-20000000001809" />
                </beneficiary>
                <relationship>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/subscriber-relationship" />
                        <code value="self" />
                        <display value="Self" />
                    </coding>
                </relationship>
                <period>
                    <start value="1983-03-24" />
                </period>
                <payor>
                    <identifier>
                        <value value="Centers for Medicare and Medicaid Services" />
                    </identifier>
                </payor>
                <class>
                    <type>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="group" />
                            <display value="Group" />
                        </coding>
                    </type>
                    <value value="Medicare" />
                </class>
                <class>
                    <type>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="plan" />
                            <display value="Plan" />
                        </coding>
                    </type>
                    <value value="Part B" />
                </class>
            </Coverage>
        </resource>
    </entry>
    <entry>
        <resource>
            <Coverage xmlns="http://hl7.org/fhir">
                <id value="part-c--20000000001809" />
                <meta>
                    <lastUpdated value="2021-06-08T01:50:57.614+00:00" />
                    <profile value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage" />
                </meta>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_01" />
                        <code value="C" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_02" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_03" />
                        <code value="C" />
                    </valueCoding>
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                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_04" />
                        <code value="C" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_05" />
                        <code value="C" />
                    </valueCoding>
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                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_06" />
                        <code value="C" />
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                        <code value="C" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_08" />
                        <code value="C" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_09" />
                        <code value="C" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_10" />
                        <code value="C" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_11" />
                        <code value="C" />
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                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_cntrct_id_12" />
                        <code value="C" />
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_01" />
                        <code value="C" />
                    </valueCoding>
                </extension>
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                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_02" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_03" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_04" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_05" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_06" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_07" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_08" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_09" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_10" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_11" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_pbp_id_12" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_01" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_02" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_03" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_04" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_05" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_06" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_07" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_08" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_09" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_10" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_11" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptc_plan_type_cd_12" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_01" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_02" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_03" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_04" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_05" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_06" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_07" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_08" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_09" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_10" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_11" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/hmo_ind_12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/hmo_ind_12" />
                        <code value="D" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rfrnc_yr">
                    <valueDate value="0003" />
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_01" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_02" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_03" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_04" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_05" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_06" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_07" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_08" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_09" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_10" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_11" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_12" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <status value="active" />
                <type>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode" />
                        <code value="SUBSIDIZ" />
                    </coding>
                </type>
                <subscriberId value="1SQ3F00AA00" />
                <beneficiary>
                    <reference value="Patient/-20000000001809" />
                </beneficiary>
                <relationship>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/subscriber-relationship" />
                        <code value="self" />
                        <display value="Self" />
                    </coding>
                </relationship>
                <payor>
                    <identifier>
                        <value value="Centers for Medicare and Medicaid Services" />
                    </identifier>
                </payor>
                <class>
                    <type>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="group" />
                            <display value="Group" />
                        </coding>
                    </type>
                    <value value="Medicare" />
                </class>
                <class>
                    <type>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="plan" />
                            <display value="Plan" />
                        </coding>
                    </type>
                    <value value="Part C" />
                </class>
            </Coverage>
        </resource>
    </entry>
    <entry>
        <resource>
            <Coverage xmlns="http://hl7.org/fhir">
                <id value="part-d--20000000001809" />
                <meta>
                    <lastUpdated value="2021-06-08T01:50:57.614+00:00" />
                    <profile value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage" />
                </meta>
                <extension url="https://bluebutton.cms.gov/resources/variables/ms_cd">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ms_cd" />
                        <code value="10" />
                        <display value="Aged without end-stage renal disease (ESRD)" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct01" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct02" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct03" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct04" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct05" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct06" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct07" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct08" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct09" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct10" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct11" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct12" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct01/3-1">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct01" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct02/3-2">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct02" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct03/3-3">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct03" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct04/3-4">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct04" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct05/3-5">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct05" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct06/3-6">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct06" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct07/3-7">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct07" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct08/3-8">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct08" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct09/3-9">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct09" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct10/3-10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct10" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct11/3-11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct11" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdcntrct12/3-12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdcntrct12" />
                        <code value="Z0010" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid01" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid02" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid03" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid04" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid05" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid06" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid07" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid08" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid09" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid10" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid11" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/ptdpbpid12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/ptdpbpid12" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid01" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid02" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid03" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid04" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid05" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid06" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid07" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid08" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid09" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid10" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid11" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/sgmtid12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/sgmtid12" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr01" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr02" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr03" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr04" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr05" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr06" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr07" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr08" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr09" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr10" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr11" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/cstshr12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/cstshr12" />
                        <code value="BB" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind01" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind02" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind03" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind04" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind05" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind06" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind07" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind08" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind09" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind10" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind11" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rdsind12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/rdsind12" />
                        <code value="C" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/rfrnc_yr">
                    <valueDate value="0003" />
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_01">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_01" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_02">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_02" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_03">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_03" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_04">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_04" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_05">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_05" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_06">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_06" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_07">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_07" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_08">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_08" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_09">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_09" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_10">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_10" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_11">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_11" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <extension url="https://bluebutton.cms.gov/resources/variables/dual_12">
                    <valueCoding>
                        <system value="https://bluebutton.cms.gov/resources/variables/dual_12" />
                        <code value="AA" />
                    </valueCoding>
                </extension>
                <status value="active" />
                <type>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode" />
                        <code value="SUBSIDIZ" />
                    </coding>
                </type>
                <subscriberId value="1SQ3F00AA00" />
                <beneficiary>
                    <reference value="Patient/-20000000001809" />
                </beneficiary>
                <relationship>
                    <coding>
                        <system value="http://terminology.hl7.org/CodeSystem/subscriber-relationship" />
                        <code value="self" />
                        <display value="Self" />
                    </coding>
                </relationship>
                <payor>
                    <identifier>
                        <value value="Centers for Medicare and Medicaid Services" />
                    </identifier>
                </payor>
                <class>
                    <type>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="group" />
                            <display value="Group" />
                        </coding>
                    </type>
                    <value value="Medicare" />
                </class>
                <class>
                    <type>
                        <coding>
                            <system value="http://terminology.hl7.org/CodeSystem/coverage-class" />
                            <code value="plan" />
                            <display value="Plan" />
                        </coding>
                    </type>
                    <value value="Part D" />
                </class>
            </Coverage>
        </resource>
    </entry>
</Bundle>