QI-Core Implementation Guide
7.0.0-ballot - STU7 Ballot United States of America flag

This page is part of the Quality Improvement Core Framework (v7.0.0-ballot: STU7 (v7.0.0) Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 6.0.0. For a full list of available versions, see the Directory of published versions

Example Claim: Claim example

Generated Narrative: Claim example

identifier: http://happysight.com/claim/6612346

status: Active

type: Vision

use: Claim

patient: Jim Chalmers Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --> (ongoing)))

created: 2014-08-16

insurer: Organization Health Level Seven International

provider: Practitioner Adam Careful

priority: Normal

prescription: MedicationRequest: status = active; intent = order; medication[x] = ->Medication alemtuzumab 10 MG/ML [Lemtrada]; authoredOn = 2015-03-25 19:32:52-0500

Payees

-TypeParty
*ProviderPractitioner Adam Careful

CareTeams

-SequenceProvider
*1Practitioner Adam Careful

Diagnoses

-SequenceDiagnosis[x]
*1H44.23

Insurances

-SequenceFocalCoverage
*1trueCoverage: identifier = Member Number; status = active; type = Other Private Insurance; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23; order = 9

item

sequence: 1

careTeamSequence: 1

productOrService: glasses

serviced: 2014-08-16

UnitPrices

-ValueCurrency
*214.00United States dollar

detail

sequence: 1

productOrService: frame

UnitPrices

-ValueCurrency
*100.00United States dollar

Nets

-ValueCurrency
*100.00United States dollar

detail

sequence: 2

productOrService: lens

quantity: 2

UnitPrices

-ValueCurrency
*50.00United States dollar

Nets

-ValueCurrency
*100.00United States dollar

detail

sequence: 3

productOrService: fst

UnitPrices

-ValueCurrency
*200.00United States dollar

factor: 0.07

Nets

-ValueCurrency
*14.00United States dollar