R5 Final QA

This page is part of the FHIR Specification (v5.0.0-draft-final: Final QA Preview for R5 - 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

Example Claim/100152 (Turtle)

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

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

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:id [ fhir:v "100152"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"
  ] ; # 
  fhir:contained ( [
     a fhir:Organization ;
     fhir:id [ fhir:v "org-insurer" ] ;
     fhir:identifier ( [
       fhir:system [ fhir:v "http://www.bindb.com/bin"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "123456" ]
     ] )
  ] [
     a fhir:Organization ;
     fhir:id [ fhir:v "org-org" ] ;
     fhir:identifier ( [
       fhir:system [ fhir:v "http://www.jurisdiction.com/oralhealthoffices"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "3456" ]
     ] )
  ] [
     a fhir:Practitioner ;
     fhir:id [ fhir:v "provider-1" ] ;
     fhir:identifier ( [
       fhir:system [ fhir:v "http://www.jurisdiction.com/oralhealthproviders"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "123456789" ]
     ] )
  ] [
     a fhir:Patient ;
     fhir:id [ fhir:v "patient-1" ] ;
     fhir:name ( [
       fhir:use [ fhir:v "official" ] ;
       fhir:family [ fhir:v "Donald" ] ;
       fhir:given ( [ fhir:v "Duck" ] )
     ] ) ;
     fhir:gender [ fhir:v "male" ] ;
     fhir:birthDate [ fhir:v "1986-05-17"^^xsd:date ] ;
     fhir:address ( [
       fhir:use [ fhir:v "home" ] ;
       fhir:line ( [ fhir:v "1234 Main Street" ] ) ;
       fhir:city [ fhir:v "Vancouver" ] ;
       fhir:postalCode [ fhir:v "V2H1Y3" ] ;
       fhir:country [ fhir:v "CAD" ]
     ] )
  ] [
     a fhir:Coverage ;
     fhir:id [ fhir:v "coverage-1" ] ;
     fhir:identifier ( [
       fhir:system [ fhir:v "http://benefitsinc.com/certificate"^^xsd:anyURI ] ;
       fhir:value [ fhir:v "12345" ]
     ] ) ;
     fhir:status [ fhir:v "active" ] ;
     fhir:kind [ fhir:v "insurance" ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "EHCPOL" ]
       ] )
     ] ;
     fhir:subscriber [
       fhir:reference [ fhir:v "#patient-1" ]
     ] ;
     fhir:beneficiary [
       fhir:reference [ fhir:v "#patient-1" ]
     ] ;
     fhir:dependent [ fhir:v "1" ] ;
     fhir:relationship [
       fhir:coding ( [
         fhir:code [ fhir:v "self" ]
       ] )
     ] ;
     fhir:insurer [
       fhir:identifier [
         fhir:system [ fhir:v "http://www.bindb.com/bin"^^xsd:anyURI ] ;
         fhir:value [ fhir:v "123456" ]
       ]
     ] ;
     fhir:class ( [
       fhir:type [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "plan" ]
         ] )
       ] ;
       fhir:value [
         fhir:value [ fhir:v "CBI35" ]
       ] ;
       fhir:name [ fhir:v "Corporate Baker's Inc. Plan#35" ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "subplan" ]
         ] )
       ] ;
       fhir:value [
         fhir:value [ fhir:v "123" ]
       ] ;
       fhir:name [ fhir:v "Trainee Part-time Benefits" ]
     ] [
       fhir:type [
         fhir:coding ( [
           fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "sequence" ]
         ] )
       ] ;
       fhir:value [
         fhir:value [ fhir:v "1" ]
       ]
     ] )
  ] ) ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://happyvalley.com/claim"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "12347" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "oral" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
     fhir:reference [ fhir:v "#patient-1" ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:insurer [
     fhir:reference [ fhir:v "#org-insurer" ]
  ] ; # 
  fhir:provider [
     fhir:reference [ fhir:v "#org-org" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:payee [
     fhir:type [
       fhir:coding ( [
         fhir:code [ fhir:v "provider" ]
       ] )
     ]
  ] ; # 
  fhir:careTeam ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:provider [
       fhir:reference [ fhir:v "#provider-1" ]
     ]
  ] ) ; # 
  fhir:diagnosis ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:code [ fhir:v "123456" ]
       ] )
     ]
  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
     fhir:coverage [
       fhir:reference [ fhir:v "#coverage-1" ]
     ]
  ] ) ; # 
  fhir:item ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:code [ fhir:v "1200" ]
       ] )
     ] ;
     fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:unitPrice [
       fhir:value [ fhir:v "135.57"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v "135.57"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] )] . # 

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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.