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/100153 (Turtle)
Raw Turtle (+ also see Turtle/RDF Format Specification)
PreAuthorization with Orthodontic Treatment Plan
@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 "100153"] ; #
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:identifier ( [
fhir:system [ fhir:v "http://happyvalley.com/claim"^^xsd:anyURI ] ;
fhir:value [ fhir:v "12355" ]
] ) ; #
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 "preauthorization"] ; #
fhir:patient [
fhir:reference [ fhir:v "Patient/1" ]
] ; #
fhir:created [ fhir:v "2015-03-16"^^xsd:date] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/2" ]
] ; #
fhir:provider [
fhir:reference [ fhir:v "Organization/1" ]
] ; #
fhir:priority [
fhir:coding ( [
fhir:code [ fhir:v "normal" ]
] )
] ; #
fhir:fundsReserve [
fhir:coding ( [
fhir:code [ fhir:v "provider" ]
] )
] ; #
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 "Practitioner/example" ]
]
] ) ; #
fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:CodeableConcept ;
fhir:coding ( [
fhir:system [ fhir:v "http://hl7.org/fhir/sid/icd-10"^^xsd:anyURI ] ;
fhir:code [ fhir:v "K07.3" ] # <code value=\"123457\"\/>
] )
]
] ) ; #
fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/9876B1" ]
]
] ) ; #
fhir:item ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:diagnosisSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ORTHPLAN" ]
] )
] ;
fhir:serviced [ fhir:v "2015-05-16"^^xsd:date ] ;
fhir:unitPrice [
fhir:value [ fhir:v "9000.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ; # Start Date
fhir:net [
fhir:value [ fhir:v "9000.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:detail ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ORTHOEXAM" ]
] )
] ; # Exam Fee
fhir:unitPrice [
fhir:value [ fhir:v "1000.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "1000.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ORTHODIAG" ]
] )
] ; # Diagnostic Fee
fhir:unitPrice [
fhir:value [ fhir:v "1500.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "1500.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ORTHOINITIAL" ]
] )
] ; # Initial Payment
fhir:unitPrice [
fhir:value [ fhir:v "500.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "500.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:sequence [ fhir:v "4"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ORTHOMONTHS" ]
] )
] ; # Duration in Months
fhir:quantity [
fhir:value [ fhir:v "24"^^xsd:decimal ]
]
] [
fhir:sequence [ fhir:v "5"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ORTHOPERIODIC" ]
] )
] ; # Periodic Payments
fhir:quantity [
fhir:value [ fhir:v "24"^^xsd:decimal ]
] ;
fhir:unitPrice [
fhir:value [ fhir:v "250.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "250.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] )
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "21211" ]
] )
] ;
fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:unitPrice [
fhir:value [ fhir:v "105.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "105.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:bodySite ( [
fhir:site ( [
fhir:concept [
fhir:coding ( [
fhir:system [ fhir:v "http://fdi.org/fhir/oraltoothcodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "21" ]
] )
]
] ) ;
fhir:subSite ( [
fhir:coding ( [
fhir:system [ fhir:v "http://fdi.org/fhir/oralsurfacecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "L" ]
] )
] )
] )
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "27211" ]
] )
] ;
fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:unitPrice [
fhir:value [ fhir:v "1100.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "1100.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:bodySite ( [
fhir:site ( [
fhir:concept [
fhir:coding ( [
fhir:system [ fhir:v "http://fdi.org/fhir/oraltoothcodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "36" ]
] )
]
] )
] ) ;
fhir:detail ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "27211" ]
] )
] ;
fhir:unitPrice [
fhir:value [ fhir:v "750.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "750.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "lab" ]
] )
] ;
fhir:unitPrice [
fhir:value [ fhir:v "350.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
] ;
fhir:net [
fhir:value [ fhir:v "350.00"^^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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