R4 Ballot #2 (Mixed Normative/Trial use)

This page is part of the FHIR Specification (v3.5.0: 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

Claim-example-oral-contained.ttl

Financial Management Work GroupMaturity Level: N/ABallot Status: InformativeCompartments: Encounter, Patient, Practitioner, RelatedPerson

Raw Turtle (+ also see Turtle/RDF Format Specification)

SOA Dental Claim (Contained)

@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://terminology.hl7.org/CodeSystem/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://terminology.hl7.org/CodeSystem/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://terminology.hl7.org/CodeSystem/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://terminology.hl7.org/CodeSystem/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://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "oral" ]
     ]
  ];
  fhir:Claim.use [ fhir:value "claim"];
  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.billcode [
       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:Money.value [ fhir:value "135.57"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "135.57"^^xsd:decimal ];
       fhir:Money.currency [ 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.