This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). 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
{ "resourceType": "Claim", "id": "100155", "text": { "status": "generated", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>" }, "contained": [ { "resourceType": "Patient", "id": "patient-1", "name": [ { "use": "official", "family": [ "Donald" ], "given": [ "Duck" ] } ], "gender": "male", "birthDate": "1986-05-17", "address": [ { "use": "home", "line": [ "1234 Main Street" ], "city": "Vancouver", "postalCode": "V2H1Y3", "country": "CAD" } ] } ], "identifier": [ { "system": "http://happyvalley.com/claim", "value": "12347" } ], "status": "active", "type": { "system": "http://hl7.org/fhir/ex-claimtype", "code": "oral" }, "created": "2014-08-16", "insurerIdentifier": { "system": "http://www.jurisdiction.com/insurers", "value": "123456" }, "organizationIdentifier": { "system": "http://www.jurisdiction.com/careorganizations", "value": "HOSP12345" }, "use": "complete", "priority": { "code": "normal" }, "payee": { "type": { "code": "provider" } }, "diagnosis": [ { "sequence": 1, "diagnosis": { "code": "123456" } } ], "patientReference": { "reference": "#patient-1" }, "coverage": [ { "sequence": 1, "focal": true, "coverageIdentifier": { "system": "http://www.jurisdiction.com/nationalplan", "value": "123AB345" } } ], "item": [ { "sequence": 1, "careTeam": [ { "providerIdentifier": { "system": "http://www.jurisdiction.com/providerId", "value": "MD98765" } } ], "service": { "code": "1200" }, "servicedDate": "2014-08-16", "unitPrice": { "value": 135.57, "system": "urn:iso:std:iso:4217", "code": "USD" }, "net": { "value": 135.57, "system": "urn:iso:std:iso:4217", "code": "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.