This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions
. Page versions: R5 R4B R4 R3
Simple Institutional Service Claim
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xs: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir//Claim/960150> a fhir:Claim;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "960150"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ]
];
fhir:Claim.type [ fhir:value "institutional"];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://happyhospital.com/claim" ];
fhir:Identifier.value [ fhir:value "9612345" ]
];
fhir:Claim.created [ fhir:value "2014-08-16"^^xs:date];
fhir:Claim.targetReference [
fhir:reference <http://hl7.org/fhir/Organization/2>;
fhir:Reference.reference [ fhir:value "Organization/2" ]
];
fhir:Claim.organizationReference [
fhir:reference <http://hl7.org/fhir/Organization/1>;
fhir:Reference.reference [ fhir:value "Organization/1" ]
];
fhir:Claim.use [ fhir:value "complete"];
fhir:Claim.priority [
fhir:Coding.code [ fhir:value "normal" ]
];
fhir:Claim.entererIdentifier [
fhir:Identifier.system [ fhir:value "http://jurisdiction.org/facilities/HOSP1234/users" ];
fhir:Identifier.value [ fhir:value "UC1234" ]
];
fhir:Claim.facilityIdentifier [
fhir:Identifier.system [ fhir:value "http://jurisdiction.org/facilities" ];
fhir:Identifier.value [ fhir:value "HOSP1234" ]
];
fhir:Claim.payee [
fhir:Claim.payee.type [
fhir:Coding.code [ fhir:value "provider" ] ]
];
fhir:Claim.diagnosis [
fhir:index 0;
fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xs:int ];
fhir:Claim.diagnosis.diagnosis [
fhir:Coding.code [ fhir:value "654456" ] ]
];
fhir:Claim.patientReference [
fhir:reference <http://hl7.org/fhir/Patient/1>;
fhir:Reference.reference [ fhir:value "Patient/1" ]
];
fhir:Claim.coverage [
fhir:index 0;
fhir:Claim.coverage.sequence [ fhir:value "1"^^xs:int ];
fhir:Claim.coverage.focal [ fhir:value "true"^^xs:boolean ];
fhir:Claim.coverage.coverageReference [
fhir:reference <http://hl7.org/fhir/Coverage/9876B1>;
fhir:Reference.reference [ fhir:value "Coverage/9876B1" ] ]
];
fhir:Claim.item [
fhir:index 0;
fhir:Claim.item.sequence [ fhir:value "1"^^xs:int ];
fhir:Claim.item.type [
fhir:Coding.code [ fhir:value "service" ] ];
fhir:Claim.item.providerReference [
fhir:reference <http://hl7.org/fhir/Practitioner/example>;
fhir:Reference.reference [ fhir:value "Practitioner/example" ] ];
fhir:Claim.item.service [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-serviceproduct" ];
fhir:Coding.code [ fhir:value "exam" ] ];
fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xs:date ];
fhir:Claim.item.unitPrice [
fhir:Quantity.value [ fhir:value "125.00"^^xs:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ] ];
fhir:Claim.item.net [
fhir:Quantity.value [ fhir:value "125.00"^^xs:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ] ]
];
fhir:Claim.total [
fhir:Quantity.value [ fhir:value "125.00"^^xs:decimal ];
fhir:Quantity.system [ fhir:value "urn:iso:std:iso:4217" ];
fhir:Quantity.code [ fhir:value "USD" ]
].
# -------------------------------------------------------------------------------------
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.