Release 5 Ballot

This page is part of the FHIR Specification (v5.0.0-ballot: FHIR R5 Ballot Preview). 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

Example Claim/960151 (Turtle)

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

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

Rich Institutional Service Claim

@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 "960151"];
  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 Claim</div>"
  ];
  fhir:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://happyhospital.com/claim" ];
     fhir:Identifier.value [ fhir:value "96123451" ]
  ];
  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 "institutional" ]
     ]
  ];
  fhir:Claim.use [ fhir:value "claim"];
  fhir:Claim.patient [
     fhir:Reference.reference [ fhir:value "Patient/1" ]
  ];
  fhir:Claim.billablePeriod [
     fhir:Period.start [ fhir:value "2014-08-15"^^xsd:date ];
     fhir:Period.end [ fhir:value "2014-08-16"^^xsd:date ]
  ];
  fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:Claim.enterer [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "http://jurisdiction.org/facilities/HOSP1234/users" ];
       fhir:Identifier.value [ fhir:value "UC1234" ]
     ]
  ];
  fhir:Claim.insurer [
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  fhir:Claim.provider [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "http://npid.org/providerid" ];
       fhir:Identifier.value [ fhir:value "NJ12345" ]
     ]
  ];
  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.facility [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "http://jurisdiction.org/facilities" ];
       fhir:Identifier.value [ fhir:value "HOSP1234" ]
     ]
  ];
  fhir:Claim.diagnosisRelatedGroup [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosisrelatedgroup" ];
       fhir:Coding.code [ fhir:value "400" ];
       fhir:Coding.display [ fhir:value "Head trauma - concussion" ]
     ]
  ];
  fhir:Claim.careTeam [
     fhir:index 0;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.careTeam.provider [
       fhir:Reference.reference [ fhir:value "Practitioner/example" ]
     ];
     fhir:Claim.careTeam.responsible [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.careTeam.role [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/claim-careteamrole" ];
         fhir:Coding.code [ fhir:value "primary" ]
       ]
     ];
     fhir:Claim.careTeam.specialty [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/provider-qualification" ];
         fhir:Coding.code [ fhir:value "physician" ]
       ]
     ]
  ];
  fhir:Claim.supportingInfo [
     fhir:index 0;
     fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
         fhir:Coding.code [ fhir:value "employmentimpacted" ]
       ]
     ];
     fhir:Claim.supportingInfo.timingPeriod [
       fhir:Period.start [ fhir:value "2014-08-16"^^xsd:date ];
       fhir:Period.end [ fhir:value "2014-08-16"^^xsd:date ]
     ]
  ], [
     fhir:index 1;
     fhir:Claim.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
         fhir:Coding.code [ fhir:value "hospitalized" ]
       ]
     ];
     fhir:Claim.supportingInfo.timingPeriod [
       fhir:Period.start [ fhir:value "2014-08-15"^^xsd:date ];
       fhir:Period.end [ fhir:value "2014-08-16"^^xsd:date ]
     ]
  ];
  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 "654456" ]
       ]
     ];
     fhir:Claim.diagnosis.type [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ];
         fhir:Coding.code [ fhir:value "admitting" ]
       ]
     ]
  ];
  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/9876B1" ]
     ];
     fhir:Claim.insurance.businessArrangement [ fhir:value "BA987123" ];
     fhir:Claim.insurance.preAuthRef [
       fhir:value "PA2014G56473";
       fhir:index 0
     ]
  ];
  fhir:Claim.accident [
     fhir:Claim.accident.date [ fhir:value "2014-07-09"^^xsd:date ];
     fhir:Claim.accident.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActIncidentCode" ];
         fhir:Coding.code [ fhir:value "SPT" ];
         fhir:Coding.display [ fhir:value "Sporting Accident" ]
       ]
     ];
     fhir:Claim.accident.locationAddress [
       fhir:Address.text [ fhir:value "Grouse Mountain Ski Hill" ]
     ]
  ];
  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.system [ fhir:value "http://hl7.org/fhir/ex-serviceproduct" ];
         fhir:Coding.code [ fhir:value "exam" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "125.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "125.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ]
  ];
  fhir:Claim.total [
     fhir:Money.value [ fhir:value "125.00"^^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.