Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1

Publication Build: This will be filled in by the publication tooling

## Example Coverage: CoverageExample

Page standards status: Informative

Generated Narrative: Coverage CoverageExample

status: Active

subscriber: Anonymous Patient Male, DoB: 1996-12-23

subscriberId: PFP123450000

beneficiary: Anonymous Patient Male, DoB: 1996-12-23

relationship: Self

period: 2022-01-01 --> 2023-01-01

payor: Organization Insurance Company

### Classes

- | Type | Value | Name
* | Plan | Premim Family Plus | Premim Family Plus Plan

> Generated Narrative: Organization #OrgExample

> identifier: Clinical Laboratory Improvement Amendments/10D0202020

> active: true

> type: Payer

> name: Insurance Company

> telecom: ph: 860-547-5001(Work)

> address: 680 Asylum Street Hartford CT 06155 US