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
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)
SOA Dental Claim using identifiers and Contained
{ "resourceType": "Claim", "id": "100155", "text": { "status": "generated", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>" }, "contained": [ { "resourceType": "Patient", "id": "patient-1", "name": [ { "use": "official", "family": "Donald", "given": [ "Duck" ] } ], "gender": "male", "birthDate": "1986-05-17", "address": [ { "use": "home", "line": [ "1234 Main Street" ], "city": "Vancouver", "postalCode": "V2H1Y3", "country": "CAD" } ] } ], "identifier": [ { "system": "http://happyvalley.com/claim", "value": "12347" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "oral" } ] }, "use": "claim", "patient": { "reference": "#patient-1" }, "created": "2014-08-16", "insurer": { "identifier": { "system": "http://www.jurisdiction.com/insurers", "value": "123456" } }, "provider": { "identifier": { "system": "http://www.jurisdiction.com/careorganizations", "value": "HOSP12345" } }, "priority": { "coding": [ { "code": "normal" } ] }, "payee": { "type": { "coding": [ { "code": "provider" } ] } }, "careTeam": [ { "sequence": 1, "provider": { "identifier": { "system": "http://www.jurisdiction.com/providerId", "value": "MD98765" } } } ], "diagnosis": [ { "sequence": 1, "diagnosisCodeableConcept": { "coding": [ { "code": "123456" } ] } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "http://www.jurisdiction.com/nationalplan/123AB345" } } ], "item": [ { "sequence": 1, "careTeamSequence": [ 1 ], "productOrService": { "coding": [ { "code": "1200" } ] }, "servicedDate": "2014-08-16", "unitPrice": { "value": 135.57, "currency": "USD" }, "net": { "value": 135.57, "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.