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 |
Raw JSON (canonical form + also see JSON Format Specification)
Simple Pharmacy Compound Claim
{ "resourceType": "Claim", "id": "760152", "text": { "status": "generated", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>" }, "identifier": [ { "system": "http://happypharma.com/claim", "value": "7612345" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "use": "claim", "patient": { "reference": "Patient/1" }, "created": "2014-08-16", "insurer": { "reference": "Organization/2" }, "provider": { "reference": "Organization/1" }, "priority": { "coding": [ { "code": "stat" } ] }, "payee": { "type": { "coding": [ { "code": "provider" } ] } }, "careTeam": [ { "sequence": 1, "provider": { "reference": "Practitioner/example" } } ], "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "code": "pharmacyrefill" } ] }, "code": { "coding": [ { "system": "http://example.org/fhir/CodeSystem/pharmacy-refill", "code": "new" } ] } }, { "sequence": 2, "category": { "coding": [ { "code": "pharmacyinformation" } ] }, "code": { "coding": [ { "system": "http://example.org/fhir/CodeSystem/pharmacy-information", "code": "refillsremaining" } ] }, "valueQuantity": { "value": 0 } }, { "sequence": 3, "category": { "coding": [ { "code": "pharmacyinformation" } ] }, "code": { "coding": [ { "system": "http://example.org/fhir/CodeSystem/pharmacy-information", "code": "dayssupply" } ] }, "valueQuantity": { "value": 10 } }, { "sequence": 4, "category": { "coding": [ { "code": "pharmacy" } ] }, "code": { "coding": [ { "system": "http://example.org/fhir/CodeSystem/pharmacy-form", "code": "capsule" } ] } } ], "diagnosis": [ { "sequence": 1, "diagnosisCodeableConcept": { "coding": [ { "code": "654456" } ] } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "Coverage/9876B1" } } ], "item": [ { "sequence": 1, "careTeamSequence": [ 1 ], "informationSequence": [ 1, 2, 3, 4 ], "productOrService": { "coding": [ { "system": "http://localdruglist.org", "code": "compound", "display": "Custom compound" } ] }, "servicedDate": "2014-08-16", "quantity": { "value": 30, "unit": "TAB", "system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm", "code": "TAB" }, "net": { "value": 155.00, "currency": "USD" }, "detail": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://localdruglist.org", "code": "44001", "display": "Acetaminophen 250mg" } ] }, "quantity": { "value": 250, "unit": "mg" }, "net": { "value": 20.00, "currency": "USD" }, "subDetail": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/ex-pharmaservice", "code": "drugcost" } ] }, "net": { "value": 20.00, "currency": "USD" } } ] }, { "sequence": 2, "productOrService": { "coding": [ { "system": "http://localdruglist.org", "code": "44035", "display": "Phenacetin 50mg" } ] }, "quantity": { "value": 50, "unit": "mg" }, "net": { "value": 25.00, "currency": "USD" }, "subDetail": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/ex-pharmaservice", "code": "drugcost" } ] }, "net": { "value": 25.00, "currency": "USD" } } ] }, { "sequence": 3, "productOrService": { "coding": [ { "system": "http://localdruglist.org", "code": "44057", "display": "Codeine 25mg" } ] }, "quantity": { "value": 25, "unit": "mg" }, "net": { "value": 28.00, "currency": "USD" }, "subDetail": [ { "sequence": 1, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/ex-pharmaservice", "code": "drugcost" } ] }, "net": { "value": 28.00, "currency": "USD" } } ] }, { "sequence": 2, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/ex-pharmaservice", "code": "markup" } ] }, "net": { "value": 22.00, "currency": "USD" } }, { "sequence": 3, "productOrService": { "coding": [ { "system": "http://hl7.org/fhir/ex-pharmaservice", "code": "compoundfee" } ] }, "net": { "value": 60.00, "currency": "USD" } } ] } ], "total": { "value": 155.00, "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.
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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