@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/us/davinci-pct/ExplanationOfBenefit/PCT-AEOB-1> a fhir:ExplanationOfBenefit ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "PCT-AEOB-1"] ; # 
  fhir:meta [
     fhir:profile ( [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-aeob>
     ] )
  ] ; # 
  fhir:text [
     fhir:status [ fhir:v "extensions" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ExplanationOfBenefit PCT-AEOB-1</b></p><a name=\"PCT-AEOB-1\"> </a><a name=\"hcPCT-AEOB-1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-davinci-pct-aeob.html\">PCT Advanced EOB</a></p></div><p><b>GFE Reference</b>: <a href=\"Bundle-PCT-GFE-Bundle-Inst-1.html\">Bundle: identifier = http://example.com/identifiers/bundle#59688475-2324-3242-23473847; type = collection; timestamp = 2021-11-09 11:01:00+0500</a></p><p><b>Service Description</b>: Example service</p><p><b>In Network Provider Options Link</b>: <a href=\"http://example.org/out-of-network.html\">http://example.org/out-of-network.html</a></p><p><b>identifier</b>: Unique Claim Identifier/?ngen-9?</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>created</b>: 2021-10-12</p><p><b>insurer</b>: <a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></p><p><b>provider</b>: <a href=\"Organization-org1002.html\">Organization Boston Radiology Center</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><p><b>claim</b>: Identifier: <code>http://example.com/identifiers/bundle</code>/59688475-2324-3242-23473847</p><p><b>outcome</b>: Processing Complete</p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>true</td><td><a href=\"Coverage-coverage1001.html\">Coverage: extension = insurance; status = active; subscriberId = PFP123450000; relationship = Self; period = 2021-01-01 --&gt; 2022-01-01</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>revenue</b>: <span title=\"Codes:{https://www.nubc.org/CodeSystem/RevenueCodes 0611}\">Magnetic Resonance Technology (MRT) - Brain/brain stem</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>modifier</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>serviced</b>: 2022-01-01</p><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS medicalmanagement}\">Medical Management</span></td></tr></table></blockquote><h3>Adjudications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Category</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS medicalmanagement}\">Medical Management</span></td></tr><tr><td style=\"display: none\">*</td><td> </td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></td></tr><tr><td style=\"display: none\">*</td><td> </td><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member Liability</span></td></tr></table><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>200</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS memberliability}\">Member liability</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication eligible}\">Eligible Amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>190</td><td>United States dollar</td></tr></table></blockquote><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td/><td>processNote disclaimer text</td></tr></table><p><b>benefitPeriod</b>: 2022-01-01 --&gt; 2023-01-01</p><blockquote><p><b>benefitBalance</b></p><p><b>category</b>: <span title=\"Codes:{https://x12.org/codes/service-type-codes 1}\">Medical Care</span></p><p><b>unit</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-unit individual}\">Individual</span></p><p><b>term</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/benefit-term annual}\">Annual</span></p><h3>Financials</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Extension</b></td><td><b>Type</b></td><td><b>Allowed[x]</b></td><td><b>Used[x]</b></td></tr><tr><td style=\"display: none\">*</td><td/><td><span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType allowed}\">Allowed</span></td><td><span title=\"US Dollar\">$1.00</span> (USD)</td><td><span title=\"US Dollar\">$1.00</span> (USD)</td></tr></table></blockquote></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeReference>
     ] ;
     fhir:value [
       a fhir:Reference ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/Bundle/PCT-GFE-Bundle-Inst-1> ;
       fhir:reference [ fhir:v "Bundle/PCT-GFE-Bundle-Inst-1" ]
     ]
  ] [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/serviceDescription>
     ] ;
     fhir:value [
       a fhir:String ;
       fhir:v "Example service"
     ]
  ] [
     fhir:url [
       fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink"^^xsd:anyURI ;
       fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/inNetworkProviderOptionsLink>
     ] ;
     fhir:value [
       a fhir:Url ;
       fhir:v "http://example.org/out-of-network.html"^^xsd:anyURI ;
       fhir:l <http://example.org/out-of-network.html>
     ]
  ] ) ; # 
  fhir:identifier ( [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>
         ] ;
         fhir:code [ fhir:v "UCID" ]
       ] )
     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>
       ] ;
       fhir:code [ fhir:v "institutional" ] ;
       fhir:display [ fhir:v "Institutional" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "predetermination"] ; # 
  fhir:patient [
     fhir:l <http://hl7.org/fhir/us/davinci-pct/Patient/patient1001> ;
     fhir:reference [ fhir:v "Patient/patient1001" ]
  ] ; # 
  fhir:created [ fhir:v "2021-10-12"^^xsd:date] ; # 
  fhir:insurer [
     fhir:l <http://hl7.org/fhir/us/davinci-pct/Organization/org1001> ;
     fhir:reference [ fhir:v "Organization/org1001" ]
  ] ; # 
  fhir:provider [
     fhir:l <http://hl7.org/fhir/us/davinci-pct/Organization/org1002> ;
     fhir:reference [ fhir:v "Organization/org1002" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/processpriority>
       ] ;
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:claim [
     fhir:identifier [
       fhir:system [
         fhir:v "http://example.com/identifiers/bundle"^^xsd:anyURI ;
         fhir:l <http://example.com/identifiers/bundle>
       ] ;
       fhir:value [ fhir:v "59688475-2324-3242-23473847" ]
     ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:insurance ( [
     fhir:focal [ fhir:v true ] ;
     fhir:coverage [
       fhir:l <http://hl7.org/fhir/us/davinci-pct/Coverage/coverage1001> ;
       fhir:reference [ fhir:v "Coverage/coverage1001" ]
     ]
  ] ) ; # 
  fhir:item ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:revenue [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://www.nubc.org/CodeSystem/RevenueCodes"^^xsd:anyURI ;
           fhir:l <https://www.nubc.org/CodeSystem/RevenueCodes>
         ] ;
         fhir:code [ fhir:v "0611" ] ;
         fhir:display [ fhir:v "Magnetic Resonance Technology (MRT) - Brain/brain stem" ]
       ] )
     ] ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ;
           fhir:l <http://www.ama-assn.org/go/cpt>
         ] ;
         fhir:code [ fhir:v "70551" ] ;
         fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ]
       ] )
     ] ;
     fhir:modifier ( [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ;
           fhir:l <http://www.ama-assn.org/go/cpt>
         ] ;
         fhir:code [ fhir:v "70551" ] ;
         fhir:display [ fhir:v "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material" ]
       ] )
     ] ) ;
     fhir:serviced [
       a fhir:Date ;
       fhir:v "2022-01-01"^^xsd:date
     ] ;
     fhir:net [
       fhir:value [ fhir:v "200"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:adjudication ( [
       fhir:extension ( [
         fhir:url [
           fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt>
         ] ;
         fhir:value [
           a fhir:CodeableConcept ;
           fhir:coding ( [
             fhir:system [
               fhir:v "http://terminology.hl7.org/CodeSystem/medical-management-type"^^xsd:anyURI ;
               fhir:l <http://terminology.hl7.org/CodeSystem/medical-management-type>
             ] ;
             fhir:code [ fhir:v "concurrent-review" ] ;
             fhir:display [ fhir:v "Concurrent Review" ]
           ] )
         ]
       ] ) ;
       fhir:category [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS>
           ] ;
           fhir:code [ fhir:v "medicalmanagement" ] ;
           fhir:display [ fhir:v "Medical Management" ]
         ] )
       ]
     ] )
  ] ) ; # 
  fhir:adjudication ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/subjectToMedicalMgmt>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/medical-management-type"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/medical-management-type>
           ] ;
           fhir:code [ fhir:v "concurrent-review" ] ;
           fhir:display [ fhir:v "Concurrent Review" ]
         ] )
       ]
     ] ) ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS>
         ] ;
         fhir:code [ fhir:v "medicalmanagement" ] ;
         fhir:display [ fhir:v "Medical Management" ]
       ] )
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/adjudication>
         ] ;
         fhir:code [ fhir:v "submitted" ] ;
         fhir:display [ fhir:v "Submitted Amount" ]
       ] )
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS>
         ] ;
         fhir:code [ fhir:v "memberliability" ] ;
         fhir:display [ fhir:v "Member Liability" ]
       ] )
     ]
  ] ) ; # 
  fhir:total ( [
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/adjudication>
         ] ;
         fhir:version [ fhir:v "1.0.1" ] ;
         fhir:code [ fhir:v "submitted" ] ;
         fhir:display [ fhir:v "Submitted Amount" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "200"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryCS>
         ] ;
         fhir:code [ fhir:v "memberliability" ] ;
         fhir:display [ fhir:v "Member liability" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "20"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] [
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/adjudication>
         ] ;
         fhir:version [ fhir:v "1.0.1" ] ;
         fhir:code [ fhir:v "eligible" ] ;
         fhir:display [ fhir:v "Eligible Amount" ]
       ] )
     ] ;
     fhir:amount [
       fhir:value [ fhir:v "190"^^xsd:decimal ] ;
       fhir:currency [ fhir:v "USD" ]
     ]
  ] ) ; # 
  fhir:processNote ( [
     fhir:extension ( [
       fhir:url [
         fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass"^^xsd:anyURI ;
         fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/processNoteClass>
       ] ;
       fhir:value [
         a fhir:CodeableConcept ;
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAEOBProcessNoteCS"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAEOBProcessNoteCS>
           ] ;
           fhir:code [ fhir:v "disclaimer" ] ;
           fhir:display [ fhir:v "Disclaimer" ]
         ] )
       ]
     ] ) ;
     fhir:text [ fhir:v "processNote disclaimer text" ]
  ] ) ; # 
  fhir:benefitPeriod [
     fhir:start [ fhir:v "2022-01-01"^^xsd:date ] ;
     fhir:end [ fhir:v "2023-01-01"^^xsd:date ]
  ] ; # 
  fhir:benefitBalance ( [
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://x12.org/codes/service-type-codes"^^xsd:anyURI ;
           fhir:l <https://x12.org/codes/service-type-codes>
         ] ;
         fhir:code [ fhir:v "1" ] ;
         fhir:display [ fhir:v "Medical Care" ]
       ] ) ;
       fhir:text [ fhir:v "Medical Care" ]
     ] ;
     fhir:unit [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/benefit-unit"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/benefit-unit>
         ] ;
         fhir:code [ fhir:v "individual" ]
       ] )
     ] ;
     fhir:term [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/benefit-term"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/benefit-term>
         ] ;
         fhir:code [ fhir:v "annual" ]
       ] )
     ] ;
     fhir:financial ( [
       fhir:extension ( [
         fhir:url [
           fhir:v "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/us/davinci-pct/StructureDefinition/remaining-benefit>
         ] ;
         fhir:value [
           a fhir:Money ;
           fhir:value [ fhir:v "0"^^xsd:decimal ] ;
           fhir:currency [ fhir:v "USD" ]
         ]
       ] ) ;
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType"^^xsd:anyURI ;
             fhir:l <http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTFinancialType>
           ] ;
           fhir:code [ fhir:v "allowed" ]
         ] )
       ] ;
       fhir:allowed [
         a fhir:Money ;
         fhir:value [ fhir:v "1"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:used [
         a fhir:Money ;
         fhir:value [ fhir:v "1"^^xsd:decimal ] ;
         fhir:currency [ fhir:v "USD" ]
       ]
     ] )
  ] ) . # 

<http://hl7.org/fhir/us/davinci-pct/Bundle/PCT-GFE-Bundle-Inst-1> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pct/Patient/patient1001> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pct/Organization/org1001> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pct/Organization/org1002> a fhir:Us .

<http://hl7.org/fhir/us/davinci-pct/Coverage/coverage1001> a fhir:Us .

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