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
@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 xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/Claim/100154> a fhir:Claim;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "100154"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.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>"
];
fhir:Claim.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ];
fhir:Identifier.value [ fhir:value "12347" ]
];
fhir:Claim.status [ fhir:value "active"];
fhir:Claim.type [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/ex-claimtype" ];
fhir:Coding.code [ fhir:value "oral" ]
];
fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:Claim.insurerIdentifier [
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"^^xsd:positiveInteger ];
fhir:Claim.diagnosis.diagnosis [
fhir:Coding.code [ fhir:value "123456" ]
]
];
fhir:Claim.patientIdentifier [
fhir:Identifier.system [ fhir:value "http://www.jurisdiction.com/nationalId" ];
fhir:Identifier.value [ fhir:value "123AB345" ]
];
fhir:Claim.coverage [
fhir:index 0;
fhir:Claim.coverage.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.coverage.focal [ fhir:value "true"^^xsd: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"^^xsd:positiveInteger ];
fhir:Claim.item.careTeam [
fhir:index 0;
fhir:Claim.item.careTeam.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"^^xsd:date ];
fhir:Claim.item.unitPrice [
fhir:Quantity.value [ fhir:value "135.57"^^xsd: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"^^xsd: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.