General Person Primary Coverage EOB Example

@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:ExplanationOfBenefit ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "EB3500"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ExplanationOfBenefit</div>"
  ] ; # 
  fhir:identifier ( [
     fhir:system [ fhir:v "http://www.BenefitsInc.com/fhir/explanationofbenefit"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "987654321" ]
  ] ) ; # 
  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/pat1" ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:enterer [
     fhir:reference [ fhir:v "Practitioner/1" ]
  ] ; # 
  fhir:insurer [
     fhir:reference [ fhir:v "Organization/3" ]
  ] ; # 
  fhir:provider [
     fhir:reference [ fhir:v "Practitioner/1" ]
  ] ; # 
  fhir:payee [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "provider" ]
       ] )
     ] ;
     fhir:party [
       fhir:reference [ fhir:v "Organization/2" ]
     ]
  ] ; # 
  fhir:facility [
     fhir:reference [ fhir:v "Location/1" ]
  ] ; # 
  fhir:claim [
     fhir:reference [ fhir:v "Claim/100150" ]
  ] ; # 
  fhir:claimResponse [
     fhir:reference [ fhir:v "ClaimResponse/R3500" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:disposition [ fhir:v "Claim settled as per contract."] ; # 
  fhir:careTeam ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:provider [
       fhir:reference [ fhir:v "Practitioner/example" ]
     ]
  ] ) ; # 
  fhir:insurance ( [
     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:productOrService [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-USCLS"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "1205" ]
       ] )
     ] ;
     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" ]
     ] ;
     fhir:udi ( [
       fhir:reference [ fhir:v "Device/example" ]
     ] ) ;
     fhir:encounter ( [
       fhir:reference [ fhir:v "Encounter/example" ]
     ] ) ;
     fhir:adjudication ( [
       fhir:category [
         fhir:coding ( [
           fhir:code [ fhir:v "eligible" ]
         ] )
       ] ;
       fhir:amount [
         fhir:value [ fhir:v "120.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ]
     ] [
       fhir:category [
         fhir:coding ( [
           fhir:code [ fhir:v "eligpercent" ]
         ] )
       ] ;
       fhir:quantity [
         fhir:value [ fhir:v "0.80"^^xsd:decimal ]
       ]
     ] [
       fhir:category [
         fhir:coding ( [
           fhir:code [ fhir:v "benefit" ]
         ] )
       ] ;
       fhir:amount [
         fhir:value [ fhir:v "96.00"^^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:code [ fhir:v "group" ]
       ] )
     ] ;
     fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:net [
       fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:adjudication ( [
       fhir:category [
         fhir:coding ( [
           fhir:code [ fhir:v "benefit" ]
         ] )
       ] ;
       fhir:amount [
         fhir:value [ fhir:v "180.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ]
     ] ) ;
     fhir:detail ( [
       fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:code [ fhir:v "group" ]
         ] )
       ] ;
       fhir:net [
         fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:udi ( [
         fhir:reference [ fhir:v "Device/example" ]
       ] ) ;
       fhir:adjudication ( [
         fhir:category [
           fhir:coding ( [
             fhir:code [ fhir:v "benefit" ]
           ] )
         ] ;
         fhir:amount [
           fhir:value [ fhir:v "180.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ]
       ] ) ;
       fhir:subDetail ( [
         fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
         fhir:productOrService [
           fhir:coding ( [
             fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-USCLS"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "1205" ]
           ] )
         ] ;
         fhir:unitPrice [
           fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] ;
         fhir:net [
           fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ] ;
         fhir:udi ( [
           fhir:reference [ fhir:v "Device/example" ]
         ] ) ;
         fhir:adjudication ( [
           fhir:category [
             fhir:coding ( [
               fhir:code [ fhir:v "eligible" ]
             ] )
           ] ;
           fhir:amount [
             fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
             fhir:currency [ fhir:v "USD" ]
           ]
         ] [
           fhir:category [
             fhir:coding ( [
               fhir:code [ fhir:v "eligpercent" ]
             ] )
           ] ;
           fhir:quantity [
             fhir:value [ fhir:v "0.90"^^xsd:decimal ]
           ]
         ] [
           fhir:category [
             fhir:coding ( [
               fhir:code [ fhir:v "benefit" ]
             ] )
           ] ;
           fhir:amount [
             fhir:value [ fhir:v "180.00"^^xsd:decimal ] ;
             fhir:currency [ fhir:v "USD" ]
           ]
         ] )
       ] )
     ] )
  ] ) ; # 
  fhir:total ( [
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "submitted" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "135.57"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "benefit" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "96.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] )] . # 

# -------------------------------------------------------------------------------------