This page is part of the FHIR Specification (v1.8.0: STU 3 Draft). 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 R2
Glasses Claim (id = "660151")
<Claim xmlns="http://hl7.org/fhir"> <id value="660151"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Vision Claim for Glasses</div> </text> <identifier> <system value="http://happysight.com/claim"/> <value value="6612346"/> </identifier> <status value="active"/> <type> <coding> <system value="http://hl7.org/fhir/ex-claimtype"/> <code value="vision"/> </coding> </type> <use value="complete"/> <patient> <reference value="Patient/1"/> </patient> <created value="2014-08-16"/> <insurer> <reference value="Organization/2"/> </insurer> <organization> <reference value="Organization/1"/> </organization> <priority> <coding> <code value="normal"/> </coding> </priority> <prescription> <reference value="http://www.optdocs.com/prescription/12345"/> </prescription> <payee> <type> <coding> <code value="provider"/> </coding> </type> </payee> <careTeam> <sequence value="1"/> <provider> <reference value="Practitioner/example"/> </provider> </careTeam> <diagnosis> <sequence value="1"/> <diagnosisCodeableConcept> <coding> <code value="654321"/> </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-visionservice"/> <code value="glasses"/> </coding> </service> <servicedDate value="2014-08-16"/> <unitPrice> <value value="214.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="214.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </net> <detail> <sequence value="1"/> <service> <coding> <system value="http://hl7.org/fhir/ex-visionservice"/> <code value="frame"/> </coding> </service> <unitPrice> <value value="100.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="100.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </net> </detail> <detail> <sequence value="2"/> <service> <coding> <system value="http://hl7.org/fhir/ex-visionservice"/> <code value="lens"/> </coding> </service> <quantity> <value value="2"/> </quantity> <unitPrice> <value value="50.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="100.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </net> </detail> <detail> <sequence value="3"/> <service> <coding> <system value="http://hl7.org/fhir/ex-visionservice"/> <code value="fst"/> </coding> </service> <unitPrice> <value value="200.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </unitPrice> <factor value="0.07"/> <net> <value value="14.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </net> </detail> </item> </Claim>
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.