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/100151 (Turtle)

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

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

Average dental Claim with Information (Missing Teeth and Student)

@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 "100151"];
  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:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ];
     fhir:Identifier.value [ fhir:value "12346" ]
  ];
  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 "Organization/2" ]
  ];
  fhir:Claim.provider [
     fhir:Reference.reference [ fhir:value "Organization/1" ]
  ];
  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 "Practitioner/example" ]
     ]
  ];
  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 "missingtooth" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-tooth" ];
         fhir:Coding.code [ fhir:value "15" ]
       ]
     ];
     fhir:Claim.supportingInfo.timingDate [ fhir:value "2012-04-07"^^xsd:date ];
     fhir:Claim.supportingInfo.reason [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/missingtoothreason" ];
         fhir:Coding.code [ fhir:value "e" ]
       ]
     ]
  ], [
     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 "exception" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-exception" ];
         fhir:Coding.code [ fhir:value "student" ]
       ]
     ];
     fhir:Claim.supportingInfo.valueString [ fhir:value "Happy Valley Community College" ]
  ];
  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/9876B1" ]
     ]
  ];
  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://example.org/fhir/oralservicecodes" ];
         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" ]
     ]
  ], [
     fhir:index 1;
     fhir:Claim.item.sequence [ fhir:value "2"^^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://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "21211" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.bodySite [
       fhir:index 0;
       fhir:Claim.item.bodySite.site [
         fhir:index 0;
         fhir:CodeableReference.concept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
             fhir:Coding.code [ fhir:value "21" ]
           ]
         ]
       ];
       fhir:Claim.item.bodySite.subSite [
         fhir:index 0;
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oralsurfacecodes" ];
           fhir:Coding.code [ fhir:value "L" ]
         ]
       ]
     ]
  ], [
     fhir:index 2;
     fhir:Claim.item.sequence [ fhir:value "3"^^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://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "27211" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.bodySite [
       fhir:index 0;
       fhir:Claim.item.bodySite.site [
         fhir:index 0;
         fhir:CodeableReference.concept [
           fhir:CodeableConcept.coding [
             fhir:index 0;
             fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
             fhir:Coding.code [ fhir:value "36" ]
           ]
         ]
       ]
     ];
     fhir:Claim.item.detail [
       fhir:index 0;
       fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "27211" ]
         ]
       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.factor [ fhir:value "0.75"^^xsd:decimal ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ], [
       fhir:index 1;
       fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "lab" ]
         ]
       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "350.00"^^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.