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/760152 (Turtle)

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

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

Simple Pharmacy Compound 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 "760152"] ; # 
  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: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 "0"^^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 "10"^^xsd:decimal ]
     ]
  ] [
     fhir:sequence [ fhir:v "4"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:code [ fhir:v "pharmacy" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/pharmacy-form"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "capsule" ]
       ] )
     ]
  ] ) ; # 
  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:v "4"^^xsd:positiveInteger ] ) ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [ fhir:v "http://localdruglist.org"^^xsd:anyURI ] ;
         fhir:code [ fhir:v "compound" ] ;
         fhir:display [ fhir:v "Custom compound" ]
       ] )
     ] ; #   type=compoundmedication  
     fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
     fhir:quantity [
       fhir:value [ fhir:v "30"^^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 "155.00"^^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://localdruglist.org"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "44001" ] ;
           fhir:display [ fhir:v "Acetaminophen 250mg" ]
         ] )
       ] ; #   type=packagemedication  
       fhir:quantity [
         fhir:value [ fhir:v "250"^^xsd:decimal ] ;
         fhir:unit [ fhir:v "mg" ]
       ] ;
       fhir:net [
         fhir:value [ fhir:v "20.00"^^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://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "drugcost" ]
           ] )
         ] ; #   type=costitem  
         fhir:net [
           fhir:value [ fhir:v "20.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ]
       ] )
     ] [
       fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://localdruglist.org"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "44035" ] ;
           fhir:display [ fhir:v "Phenacetin 50mg" ]
         ] )
       ] ; #   type=packagemedication  
       fhir:quantity [
         fhir:value [ fhir:v "50"^^xsd:decimal ] ;
         fhir:unit [ fhir:v "mg" ]
       ] ;
       fhir:net [
         fhir:value [ fhir:v "25.00"^^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://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "drugcost" ]
           ] )
         ] ; #   type=costitem  
         fhir:net [
           fhir:value [ fhir:v "25.00"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ]
       ] )
     ] [
       fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [ fhir:v "http://localdruglist.org"^^xsd:anyURI ] ;
           fhir:code [ fhir:v "44057" ] ;
           fhir:display [ fhir:v "Codeine 25mg" ]
         ] )
       ] ; #   type=packagemedication  
       fhir:quantity [
         fhir:value [ fhir:v "25"^^xsd:decimal ] ;
         fhir:unit [ fhir:v "mg" ]
       ] ;
       fhir:net [
         fhir:value [ fhir:v "28.00"^^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://hl7.org/fhir/ex-pharmaservice"^^xsd:anyURI ] ;
             fhir:code [ fhir:v "drugcost" ]
           ] )
         ] ; #   type=costitem  
         fhir:net [
           fhir:value [ fhir:v "28.00"^^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 "22.00"^^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 "compoundfee" ]
         ] )
       ] ; #   type=costitem  
       fhir:net [
         fhir:value [ fhir:v "60.00"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ]
     ] )
  ] ) ; # 
  fhir:total [
     fhir:value [ fhir:v "155.00"^^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.