This page is part of the electronic Long-Term Services and Supports Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

eLTSS Claim Example - TTL Representation

(back to narrative)

Raw ttl

@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:Bundle;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "claim-claim1"];
  fhir:Bundle.type [ fhir:value "collection"];
  fhir:Bundle.entry [
     fhir:index 0;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/eLTSS/claim" ];
     fhir:Bundle.entry.resource <http://example.org/eLTSS/claim>
  ], [
     fhir:index 1;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/eLTSS/funding" ];
     fhir:Bundle.entry.resource <http://example.org/eLTSS/funding>
  ], [
     fhir:index 2;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/eLTSS/coverage1" ];
     fhir:Bundle.entry.resource <http://example.org/eLTSS/coverage1>
  ], [
     fhir:index 3;
     fhir:Bundle.entry.fullUrl [ fhir:value "http://example.org/eLTSS/patient1" ];
     fhir:Bundle.entry.resource <http://example.org/eLTSS/patient1>
  ].

<http://example.org/eLTSS/claim> a fhir:Claim;
  fhir:Resource.id [ fhir:value "claim1"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/eltss/StructureDefinition/claim-eltss";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/eltss/StructureDefinition/claim-eltss>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: claim1</p><p><b>meta</b>: </p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/claim-type code 'professional' = 'Professional)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient/Patient2\">Patient/Patient2</a></p><p><b>created</b>: 01/01/2019 12:00:00 AM</p><p><b>provider</b>: <a href=\"Organization/funding1\">Organization/funding1</a></p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/processpriority code 'normal' = 'Normal)</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"Coverage/coverage1\">Coverage/coverage1</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td><td><b>UnitPrice</b></td><td><b>Net</b></td></tr><tr><td>*</td><td>1</td><td>Exam, comp, primary <span style=\"background: LightGoldenRodYellow\">(Details : {http://terminology.hl7.org/CodeSystem/ex-USCLS code '1101' = 'Exam, comp, primary)</span></td><td/><td/></tr></table></div>"
  ];
  fhir:Claim.status [ fhir:value "active"];
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "professional" ]     ]
  ];
  fhir:Claim.use [ fhir:value "claim"];
  fhir:Claim.patient [
     fhir:Reference.reference [ fhir:value "Patient/Patient2" ]
  ];
  fhir:Claim.created [ fhir:value "2019-01-01"^^xsd:date];
  fhir:Claim.provider [
     fhir:Reference.reference [ fhir:value "Organization/funding1" ]
  ];
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
       fhir:Coding.code [ fhir:value "normal" ]     ]
  ];
  fhir:Claim.insurance [
     fhir:index 0;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/coverage1" ]     ]
  ];
  fhir:Claim.item [
     fhir:index 0;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-USCLS" ];
         fhir:Coding.code [ fhir:value "1101" ]       ]     ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "60.00"^^xsd:decimal ]     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "600.00"^^xsd:decimal ]     ]
  ].

<http://example.org/eLTSS/funding> a fhir:Organization;
  fhir:Resource.id [ fhir:value "funding1"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p><b>Service Funding Source:</b> Georgia Department of Community Health</p>\n          </div>"
  ];
  fhir:Organization.identifier [
     fhir:index 0;
     fhir:Identifier.value [ fhir:value "ICWP" ]
  ];
  fhir:Organization.name [ fhir:value "Georgia Department of Community Health"];
  fhir:Organization.address [
     fhir:index 0;
     fhir:Address.text [ fhir:value "2 Main Street, Atlanta GA, 30318" ]
  ].

<http://example.org/eLTSS/coverage1> a fhir:Coverage;
  fhir:Resource.id [ fhir:value "coverage1"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: coverage1</p><p><b>status</b>: active</p><p><b>beneficiary</b>: <a href=\"Patient/Patient2\">Patient/Patient2</a></p><p><b>payor</b>: <a href=\"Organization/funding1\">Organization/funding1</a></p></div>"
  ];
  fhir:Coverage.status [ fhir:value "active"];
  fhir:Coverage.beneficiary [
     fhir:Reference.reference [ fhir:value "Patient/Patient2" ]
  ];
  fhir:Coverage.payor [
     fhir:index 0;
     fhir:Reference.reference [ fhir:value "Organization/funding1" ]
  ].

<http://example.org/eLTSS/patient1> a fhir:Patient;
  fhir:Resource.id [ fhir:value "Patient2"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/eltss/StructureDefinition/patient-eltss";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/eltss/StructureDefinition/patient-eltss>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            <p><b>Person Name:</b> Sally Person</p>\n            <p><b>Person Identifier | Type:</b> 123456ABC | MRN</p>\n            <p><b>Person Phone:</b> (404) 555 1212</p>\n            <p><b>Person Date of Birth:</b> 1935-05-01</p>\n            <p><b>Person Address:</b> 2222 Peachtree Street, Atlanta GA, 30318</p>\n            <p><b>Emergency Contact Name:</b> Jane Daughter</p>\n            <p><b>Emergency Contact Relationship:</b> daughter</p>\n            <p><b>Emergency Contact Phone Number:</b> (770) 224 1544</p>\n          </div>"
  ];
  fhir:Patient.identifier [
     fhir:index 0;
     fhir:Identifier.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v2-0203" ];
         fhir:Coding.code [ fhir:value "MR" ]       ]     ];
     fhir:Identifier.system [ fhir:value "http://www.example.org/Codesystem" ];
     fhir:Identifier.value [ fhir:value "123456ABC" ]
  ];
  fhir:Patient.name [
     fhir:index 0;
     fhir:HumanName.text [ fhir:value "Sally Person" ];
     fhir:HumanName.family [ fhir:value "Person" ];
     fhir:HumanName.given [
       fhir:value "Sally";
       fhir:index 0     ]
  ];
  fhir:Patient.telecom [
     fhir:index 0;
     fhir:ContactPoint.system [ fhir:value "phone" ];
     fhir:ContactPoint.value [ fhir:value "(404) 555 1212" ]
  ];
  fhir:Patient.gender [ fhir:value "female"];
  fhir:Patient.birthDate [ fhir:value "1935-05-01"^^xsd:date];
  fhir:Patient.address [
     fhir:index 0;
     fhir:Address.text [ fhir:value "2222 Peachtree Street, Atlanta GA, 30318" ];
     fhir:Address.line [
       fhir:value "2222 Peachtree Street";
       fhir:index 0     ];
     fhir:Address.city [ fhir:value "Atlanta" ];
     fhir:Address.district [ fhir:value "Fulton" ];
     fhir:Address.state [ fhir:value "GA" ];
     fhir:Address.postalCode [ fhir:value "30318" ]
  ];
  fhir:Patient.contact [
     fhir:index 0;
     fhir:Patient.contact.relationship [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/fhir/v2/0131" ];
         fhir:Coding.code [ fhir:value "C" ]       ]     ], [
       fhir:index 1;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/fhir/v3/RoleCode" ];
         fhir:Coding.code [ fhir:value "DAUC" ]       ]     ];
     fhir:Patient.contact.name [
       fhir:HumanName.text [ fhir:value "Jane Daughter" ];
       fhir:HumanName.family [ fhir:value "Daughter" ];
       fhir:HumanName.given [
         fhir:value "Jane";
         fhir:index 0       ]     ];
     fhir:Patient.contact.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "phone" ];
       fhir:ContactPoint.value [ fhir:value "(770) 224 1544" ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.