Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

Example Claim/100156 (Turtle)

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

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

PreAuthorization with Bridge and Crown

@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 "100156"] ; # 
  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:Device ;
     fhir:id [ fhir:v "device-bridge" ]
  ] [
     a fhir:ServiceRequest ;
     fhir:id [ fhir:v "referral" ] ;
     fhir:status [ fhir:v "active" ] ;
     fhir:intent [ fhir:v "order" ] ;
     fhir:subject [
       fhir:reference [ fhir:v "Patient/1" ]
     ]
  ] ) ; #   rest of the resource ommitted for brevity  
  fhir:identifier ( [
     fhir:system [ fhir:v "http://happyvalley.com/claim"^^xsd:anyURI ] ;
     fhir:value [ fhir:v "123466" ]
  ] ) ; # 
  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 "Organization/2" ]
  ] ; # 
  fhir:provider [
     fhir:reference [ fhir:v "Organization/1" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:related ( [
     fhir:claim [
       fhir:reference [ fhir:v "Claim/100151" ]
     ] ;
     fhir:relationship [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "associated" ]
       ] )
     ] ;
     fhir:reference [
       fhir:value [ fhir:v "CASE156746B" ]
     ] #   case number  
  ] ) ; # 
  fhir:payee [
     fhir:type [
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "other" ]
       ] )
     ] ;
     fhir:party [
       fhir:reference [ fhir:v "RelatedPerson/peter" ]
     ]
  ] ; # 
  fhir:referral [
     fhir:reference [ fhir:v "#referral" ]
  ] ; # 
  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:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "prosthesis" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [ fhir:v "http://hl7.org/fhir/ex-oralprostho"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "2" ] ;
         fhir:display [ fhir:v "Maryland Bridge" ]
       ] )
     ] ;
     fhir:timing [ fhir:v "2001-04-07"^^xsd:date ]
  ] ) ; #   original placement  
  fhir:procedure ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:date [ fhir:v "2014-07-04"^^xsd:date ] ;
     fhir:procedure [
       a fhir:CodeableConcept ;
       fhir:text [ fhir:v "Resection of gum to increase exposed tooth." ]
     ]
  ] ) ; # 
  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:productOrService [
       fhir:coding ( [
         fhir:system [ fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "67221" ] ;
         fhir:display [ fhir:v "Maryland Bridge" ]
       ] )
     ] ;
     fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:location [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "11" ]
       ] )
     ] ;
     fhir:unitPrice [
       fhir:value [ fhir:v "1400.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:factor [ fhir:v "0.75"^^xsd:decimal ] ;
     fhir:net [
       fhir:value [ fhir:v "1050.00"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ; #   student discount  
     fhir:udi ( [
       fhir:reference [ fhir:v "#device-bridge" ]
     ] ) ;
     fhir:bodySite ( [
       fhir:site ( [
         fhir:concept [
           fhir:coding ( [
             fhir:system [ fhir:v "http://fdi.org/fhir/oraltoothcodes"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "01" ]
           ] )
         ]
       ] )
     ] )
  ] [
     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:location [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "11" ]
       ] )
     ] ;
     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:procedureSequence ( [ 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:location [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-serviceplace"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "11" ]
       ] )
     ] ;
     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 "24" ]
           ] )
         ]
       ] )
     ] ) ;
     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 "1000.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:factor [ fhir:v "0.75"^^xsd:decimal ] ;
       fhir:net [
         fhir:value [ fhir:v "750.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] #   Student discount  
     ] [
       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" ]
       ]
     ] )
  ] ) ; # 
  fhir:total [
     fhir:value [ fhir:v "2255.00"^^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.