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/760151 (Turtle)
Raw Turtle (+ also see Turtle/RDF Format Specification)
Simple Pharmacy Medication Claim
@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 "760151"] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>"
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "http://happypharma.com/claim"^^xsd:anyURI ] ;
fhir:value [ fhir:v "7612345" ]
] ) ; #
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 "pharmacy" ]
] )
] ; #
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 "Organization/2" ]
] ; #
fhir:provider [
fhir:reference [ fhir:v "Organization/1" ]
] ; #
fhir:priority [
fhir:coding ( [
fhir:code [ fhir:v "stat" ]
] )
] ; #
fhir:prescription [
fhir:link <http://pharmacy.org/MedicationRequest/AB1234G> ;
fhir:reference [ fhir:v "http://pharmacy.org/MedicationRequest/AB1234G" ]
] ; #
fhir:originalPrescription [
fhir:link <http://pharmacy.org/MedicationRequest/AB1202B> ;
fhir:reference [ fhir:v "http://pharmacy.org/MedicationRequest/AB1202B" ]
] ; #
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:supportingInfo ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:category [
fhir:coding ( [
fhir:code [ fhir:v "pharmacyrefill" ]
] )
] ;
fhir:code [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/pharmacy-refill"^^xsd:anyURI ] ;
fhir:code [ fhir:v "new" ]
] )
]
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:category [
fhir:coding ( [
fhir:code [ fhir:v "pharmacyinformation" ]
] )
] ;
fhir:code [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/pharmacy-information"^^xsd:anyURI ] ;
fhir:code [ fhir:v "refillsremaining" ]
] )
] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "2"^^xsd:decimal ]
]
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:category [
fhir:coding ( [
fhir:code [ fhir:v "pharmacyinformation" ]
] )
] ;
fhir:code [
fhir:coding ( [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/pharmacy-information"^^xsd:anyURI ] ;
fhir:code [ fhir:v "dayssupply" ]
] )
] ;
fhir:value [
a fhir:Quantity ;
fhir:value [ fhir:v "90"^^xsd:decimal ]
]
] ) ; #
fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:CodeableConcept ;
fhir:coding ( [
fhir:code [ fhir:v "654456" ]
] )
]
] ) ; #
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:informationSequence ( [ fhir:v "1"^^xsd:positiveInteger ] [ fhir:v "2"^^xsd:positiveInteger ] [ fhir:v "3"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://www.nlm.nih.gov/research/umls/rxnorm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "562721" ] ;
fhir:display [ fhir:v "Alprazolam 0.25mg (Xanax)" ]
] )
] ; # type=packagemedication
fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:quantity [
fhir:value [ fhir:v "90"^^xsd:decimal ] ;
fhir:unit [ fhir:v "TAB" ] ;
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TAB" ]
] ;
fhir:net [
fhir:value [ fhir:v "90.00"^^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://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "drugcost" ]
] )
] ; # type=costitem
fhir:net [
fhir:value [ fhir:v "45.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "markup" ]
] )
] ; # type=costitem
fhir:net [
fhir:value [ fhir:v "9.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:productOrService [
fhir:coding ( [
fhir:system [ fhir:v "http://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "dispensefee" ]
] )
] ; # type=costitem
fhir:net [
fhir:value [ fhir:v "36.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]
]
] )
] ) ; #
fhir:total [
fhir:value [ fhir:v "90.00"^^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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