This page is part of the Da Vinci Clinical Documentation Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions 
JSON Format: Claim-cdex-example-claim
Raw json
{
"resourceType" : "Claim",
"id" : "cdex-example-claim",
"meta" : {
"versionId" : "2",
"lastUpdated" : "2019-06-06T21:52:49.000-04:00"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Claim\n \n </div>"
},
"identifier" : [
{
"system" : "http://happypdocs.com/claim",
"value" : "8612345"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/cdex-example-patient"
},
"created" : "2019-01-02",
"insurer" : {
"reference" : "Organization/cdex-example-payer"
},
"provider" : {
"reference" : "Practitioner/cdex-example-practitioner"
},
"priority" : {
"coding" : [
{
"code" : "normal"
}
]
},
"payee" : {
"type" : {
"coding" : [
{
"code" : "provider"
}
]
}
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
"reference" : "Practitioner/cdex-example-practitioner"
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"code" : "654456"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/cdex-example-coverage"
}
}
],
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code" : "1101",
"display" : "Exam, comp, primary"
}
]
},
"servicedDate" : "2018-08-16",
"unitPrice" : {
"value" : 75
},
"net" : {
"value" : 75
}
}
]
}
