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
SOA Dental Claim using identifiers and Contained
@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/100155> a fhir:Claim;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "100155"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ]
];
fhir:DomainResource.contained [
fhir:index 0;
fhir:Patient [
fhir:index 0;
fhir:Resource.id [ fhir:value "patient-1" ];
fhir:Patient.name [
fhir:index 0;
fhir:HumanName.use [ fhir:value "official" ];
fhir:HumanName.family [
fhir:value "Donald";
fhir:index 0 ];
fhir:HumanName.given [
fhir:value "Duck";
fhir:index 0 ] ];
fhir:Patient.gender [ fhir:value "male" ];
fhir:Patient.birthDate [ fhir:value "1986-05-17"^^xs:date ];
fhir:Patient.address [
fhir:index 0;
fhir:Address.use [ fhir:value "home" ];
fhir:Address.line [
fhir:value "1234 Main Street";
fhir:index 0 ];
fhir:Address.city [ fhir:value "Vancouver" ];
fhir:Address.postalCode [ fhir:value "V2H1Y3" ];
fhir:Address.country [ fhir:value "CAD" ] ] ]
];
fhir:Claim.type [ fhir:value "oral"];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ];
fhir:Identifier.value [ fhir:value "12347" ]
];
fhir:Claim.created [ fhir:value "2014-08-16"^^xs:date];
fhir:Claim.targetIdentifier [
fhir:Identifier.system [ fhir:value "http://www.jurisdiction.com/insurers" ];
fhir:Identifier.value [ fhir:value "123456" ]
];
fhir:Claim.organizationIdentifier [
fhir:Identifier.system [ fhir:value "http://www.jurisdiction.com/careorganizations" ];
fhir:Identifier.value [ fhir:value "HOSP12345" ]
];
fhir:Claim.use [ fhir:value "complete"];
fhir:Claim.priority [
fhir:Coding.code [ fhir:value "normal" ]
];
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 "123456" ] ]
];
fhir:Claim.patientReference [
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.coverageIdentifier [
fhir:Identifier.system [ fhir:value "http://www.jurisdiction.com/nationalplan" ];
fhir:Identifier.value [ fhir:value "123AB345" ] ]
];
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.providerIdentifier [
fhir:Identifier.system [ fhir:value "http://www.jurisdiction.com/providerId" ];
fhir:Identifier.value [ fhir:value "MD98765" ] ];
fhir:Claim.item.service [
fhir:Coding.code [ fhir:value "1200" ] ];
fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xs:date ];
fhir:Claim.item.unitPrice [
fhir:Quantity.value [ fhir:value "135.57"^^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 "135.57"^^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.