QI-Core Implementation Guide
6.0.0-ballot - ballot
QI-Core Implementation Guide
6.0.0-ballot - ballot
This page is part of the Quality Improvement Core Framework (v6.0.0-ballot: STU6 (v6.0.0) Ballot 1) based on FHIR R4. The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
Resource Claim "example"
Profile: QICore Claim
identifier: id: 6612346
status: active
type: Vision (Claim Type Codes#vision)
use: claim
patient: Patient/example " CHALMERS"
created: 2014-08-16
insurer: Organization/example "Health Level Seven International"
provider: Practitioner/example " CAREFUL"
priority: Normal (Process Priority Codes#normal)
prescription: MedicationRequest/example
| Type | Party |
| Provider (Claim Payee Type Codes#provider) | Practitioner/example " CAREFUL" |
| Sequence | Provider |
| 1 | Practitioner/example " CAREFUL" |
| Sequence | Diagnosis[x] |
| 1 | 654321 (CodeSystem#654321) |
| Sequence | Focal | Coverage |
| 1 | true | Coverage/example |
item
sequence: 1
careTeamSequence: 1
productOrService: glasses (ex-visionservice#glasses)
serviced: 2014-08-16
UnitPrices
Value Currency 214.00 USD detail
sequence: 1
productOrService: frame (ex-visionservice#frame)
UnitPrices
Value Currency 100.00 USD Nets
Value Currency 100.00 USD detail
sequence: 2
productOrService: lens (ex-visionservice#lens)
quantity: 2
UnitPrices
Value Currency 50.00 USD Nets
Value Currency 100.00 USD detail
sequence: 3
productOrService: fst (ex-visionservice#fst)
UnitPrices
Value Currency 200.00 USD factor: 0.07
Nets
Value Currency 14.00 USD
IG © 2019+ http://www.hl7.org/Special/committees/cqi/index.cfm. Package hl7.fhir.us.qicore#6.0.0-ballot based on FHIR 4.0.1. Generated 2023-08-03
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QA Report
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