R4 Ballot #1 (Mixed Normative/Trial use)
This page is part of the FHIR Specification (v3.3.0: R4 Ballot 2). 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
| Financial Management Work Group | Maturity Level: N/A | Ballot Status: Informative | Compartments: Encounter, Patient, Practitioner, RelatedPerson |
SOA Dental Claim (Contained)
Financial
@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/100152> a fhir:Claim;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "100152"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"
];
fhir:DomainResource.contained [
a fhir:Organization;
fhir:index 0;
fhir:Resource.id [ fhir:value "org-insurer" ];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.bindb.com/bin" ];
fhir:Identifier.value [ fhir:value "123456" ]
]
], [
a fhir:Organization;
fhir:index 1;
fhir:Resource.id [ fhir:value "org-org" ];
fhir:Organization.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.jurisdiction.com/oralhealthoffices" ];
fhir:Identifier.value [ fhir:value "3456" ]
]
], [
a fhir:Practitioner;
fhir:index 2;
fhir:Resource.id [ fhir:value "provider-1" ];
fhir:Practitioner.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://www.jurisdiction.com/oralhealthproviders" ];
fhir:Identifier.value [ fhir:value "123456789" ]
]
], [
a fhir:Patient;
fhir:index 3;
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:HumanName.given [
fhir:value "Duck";
fhir:index 0
]
];
fhir:Patient.gender [ fhir:value "male" ];
fhir:Patient.birthDate [ fhir:value "1986-05-17"^^xsd: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" ]
]
], [
a fhir:Coverage;
fhir:index 4;
fhir:Resource.id [ fhir:value "coverage-1" ];
fhir:Coverage.identifier [
fhir:index 0;
fhir:Identifier.system [ fhir:value "http://benefitsinc.com/certificate" ];
fhir:Identifier.value [ fhir:value "12345" ]
];
fhir:Coverage.status [ fhir:value "active" ];
fhir:Coverage.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/v3/ActCode" ];
fhir:Coding.code [ fhir:value "EHCPOL" ]
]
];
fhir:Coverage.subscriber [
fhir:Reference.reference [ fhir:value "#patient-1" ]
];
fhir:Coverage.beneficiary [
fhir:Reference.reference [ fhir:value "#patient-1" ]
];
fhir:Coverage.dependent [ fhir:value "1" ];
fhir:Coverage.relationship [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "self" ]
]
];
fhir:Coverage.payor [
fhir:index 0;
fhir:Reference.identifier [
fhir:Identifier.system [ fhir:value "http://www.bindb.com/bin" ];
fhir:Identifier.value [ fhir:value "123456" ]
]
];
fhir:Coverage.class [
fhir:index 0;
fhir:Coverage.class.type [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/coverage-class" ];
fhir:Coding.code [ fhir:value "plan" ]
];
fhir:Coverage.class.value [ fhir:value "CBI35" ];
fhir:Coverage.class.name [ fhir:value "Corporate Baker's Inc. Plan#35" ]
], [
fhir:index 1;
fhir:Coverage.class.type [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/coverage-class" ];
fhir:Coding.code [ fhir:value "subplan" ]
];
fhir:Coverage.class.value [ fhir:value "123" ];
fhir:Coverage.class.name [ fhir:value "Trainee Part-time Benefits" ]
], [
fhir:index 2;
fhir:Coverage.class.type [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/coverage-class" ];
fhir:Coding.code [ fhir:value "sequence" ]
];
fhir:Coverage.class.value [ fhir:value "1" ]
]
];
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:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/claim-type" ];
fhir:Coding.code [ fhir:value "oral" ]
]
];
fhir:Claim.use [ fhir:value "complete"];
fhir:Claim.patient [
fhir:Reference.reference [ fhir:value "#patient-1" ]
];
fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
fhir:Claim.insurer [
fhir:Reference.reference [ fhir:value "#org-insurer" ]
];
fhir:Claim.provider [
fhir:Reference.reference [ fhir:value "#org-org" ]
];
fhir:Claim.priority [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "normal" ]
]
];
fhir:Claim.payee [
fhir:Claim.payee.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "provider" ]
]
]
];
fhir:Claim.careTeam [
fhir:index 0;
fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.careTeam.provider [
fhir:Reference.reference [ fhir:value "#provider-1" ]
]
];
fhir:Claim.diagnosis [
fhir:index 0;
fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.diagnosis.diagnosisCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.code [ fhir:value "123456" ]
]
]
];
fhir:Claim.insurance [
fhir:index 0;
fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:Claim.insurance.coverage [
fhir:Reference.reference [ fhir:value "#coverage-1" ]
]
];
fhir:Claim.item [
fhir:index 0;
fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:Claim.item.careTeamSequence [
fhir:value "1"^^xsd:positiveInteger;
fhir:index 0
];
fhir:Claim.item.service [
fhir:CodeableConcept.coding [
fhir:index 0;
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" ]
]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/Claim/100152.ttl> a owl:Ontology;
owl:imports fhir:fhir.ttl;
owl:versionIRI <http://build.fhir.org/Claim/100152.ttl> .
# -------------------------------------------------------------------------------------
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.
®© HL7.org 2011+. FHIR Mixed Nomative/Trial Use Ballot (v3.3.0-13671) generated on Tue, Apr 3, 2018 12:14+1000. QA Page
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