Claim-example-institutional.xml

Simple Institutional Service Claim (id = "960150")

<Claim xmlns="http://hl7.org/fhir">
 <id value="960150"/>

 <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Claim</div>
  </text>

  <identifier>
    <system value="http://happyhospital.com/claim"/>
    <value value="9612345"/>
 </identifier>
 
  <status value="active"/>

  <type>
   <coding>
    <system value="http://hl7.org/fhir/ex-claimtype"/>
    <code value="institutional"/>
   </coding>
  </type>
 
 <use value="complete"/>

 <patient>
   <reference value="Patient/1"/>
 </patient>
 
 <created value="2014-08-16"/>

 <enterer>
   <identifier>
    <system value="http://jurisdiction.org/facilities/HOSP1234/users"/>
    <value value="UC1234"/>
   </identifier>
</enterer>

 <insurer>
  <reference value="Organization/2"/>
</insurer>

 <organization>
    <reference value="Organization/1"/>
 </organization>

 <priority>
  <coding>
    <code value="normal"/>
  </coding>
 </priority>

 <payee>
   <type>
    <coding>
     <code value="provider"/>
  </coding>
   </type>
 </payee>
 
 <facility>
  <identifier>
    <system value="http://jurisdiction.org/facilities"/>
    <value value="HOSP1234"/>
  </identifier>
 </facility>
 
   <careTeam>
     <sequence value="1"/>
     <provider>
       <reference value="Practitioner/example"/>
     </provider>
   </careTeam>

   <diagnosis>
    <sequence value="1"/>
  <diagnosisCodeableConcept>
   <coding>
    <code value="654456"/>
   </coding>
  </diagnosisCodeableConcept>
  </diagnosis>
 
 <insurance>
   <sequence value="1"/>
   <focal value="true"/>
   <coverage>
     <reference value="Coverage/9876B1"/>
   </coverage>
 </insurance>
  
 <item>
   <sequence value="1"/>
   <careTeamLinkId value="1"/>
   <service>
    <coding>
     <system value="http://hl7.org/fhir/ex-serviceproduct"/>
     <code value="exam"/> 
  </coding>
   </service>
   <servicedDate value="2014-08-16"/>
   <unitPrice>
      <value value="125.00"/>
    <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/> 
   </unitPrice> 
   <net>
      <value value="125.00"/>
    <system value="urn:iso:std:iso:4217"/>
      <code value="USD"/> 
   </net> 
  </item>

  <total>
    <value value="125.00"/>
  <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>  
  </total>
</Claim>