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
Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
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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" ] ] ] )] . # # -------------------------------------------------------------------------------------
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.
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