This page is part of the FHIR Specification (v5.0.0-ballot: R5 Ballot - see ballot notes). 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 | Standards Status: Informative | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
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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 ------------------------------------------------------------------- [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.kind [ fhir:value "insurance" ]; 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.insurer [ 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:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ]; fhir:Coding.code [ fhir:value "plan" ] ] ]; fhir:Coverage.class.value [ fhir:Identifier.value [ fhir:value "CBI35" ] ]; fhir:Coverage.class.name [ fhir:value "Corporate Baker's Inc. Plan#35" ] ], [ fhir:index 1; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ]; fhir:Coding.code [ fhir:value "subplan" ] ] ]; fhir:Coverage.class.value [ fhir:Identifier.value [ fhir:value "123" ] ]; fhir:Coverage.class.name [ fhir:value "Trainee Part-time Benefits" ] ], [ fhir:index 2; fhir:Coverage.class.type [ fhir:CodeableConcept.coding [ fhir:index 0; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ]; fhir:Coding.code [ fhir:value "sequence" ] ] ]; fhir:Coverage.class.value [ fhir:Identifier.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.productOrService [ 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 ------------------------------------------------------------ [a owl:Ontology; owl:imports fhir:fhir.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.
FHIR ®© HL7.org 2011+. FHIR R5 Ballot hl7.fhir.core#5.0.0-ballot generated on Sat, Sep 10, 2022 05:01+1000.
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