Simple Institutional Service Claim
{
"resourceType": "Claim",
"id": "960150",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim</div>"
},
"identifier": [
{
"system": "http://happyhospital.com/claim",
"value": "9612345"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "institutional"
}
]
},
"subType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype",
"code": "emergency"
}
]
},
"use": "claim",
"patient": {
"reference": "Patient/1"
},
"created": "2014-08-16",
"enterer": {
"identifier": {
"system": "http://jurisdiction.org/facilities/HOSP1234/users",
"value": "UC1234"
}
},
"insurer": {
"reference": "Organization/2"
},
"provider": {
"reference": "Organization/1"
},
"priority": {
"coding": [
{
"code": "normal"
}
]
},
"payee": {
"type": {
"coding": [
{
"code": "provider"
}
]
}
},
"facility": {
"identifier": {
"system": "http://jurisdiction.org/facilities",
"value": "HOSP1234"
}
},
"careTeam": [
{
"sequence": 1,
"provider": {
"reference": "Practitioner/example"
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "654456"
}
]
}
}
],
"procedure": [
{
"sequence": 1,
"type": [
{
"coding": [
{
"code": "primary"
}
]
}
],
"date": "2014-08-16",
"procedureCodeableConcept": {
"coding": [
{
"code": "SDI9901"
}
],
"text": "Subcutaneous diagnostic implant"
},
"udi": [
{
"reference": "Device/example"
}
]
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "Coverage/9876B1"
}
}
],
"item": [
{
"sequence": 1,
"careTeamSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-serviceproduct",
"code": "exam"
}
]
},
"servicedDate": "2014-08-16",
"unitPrice": {
"value": 125.00,
"currency": "USD"
},
"net": {
"value": 125.00,
"currency": "USD"
},
"encounter": [
{
"reference": "Encounter/example"
}
]
}
],
"total": {
"value": 125.00,
"currency": "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.