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. 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.
FHIR ®© HL7.org 2011+. FHIR R5 hl7.fhir.core#5.0.0 generated on Sun, Mar 26, 2023 15:24+1100.
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