QI-Core Implementation Guide
7.0.0-ballot - STU7 Ballot
QI-Core Implementation Guide
7.0.0-ballot - STU7 Ballot
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
{
"resourceType" : "Claim",
"id" : "example",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </a><a name=\"example-en-US\"> </a><p><b>identifier</b>: <code>http://happysight.com/claim</code>/6612346</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type vision}\">Vision</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jim Chalmers Male, DoB: 1974-12-25 ( Medical record number\u00a0(use:\u00a0usual,\u00a0period:\u00a02001-05-06 --> (ongoing)))</a></p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization Health Level Seven International</a></p><p><b>provider</b>: <a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><p><b>prescription</b>: <a href=\"MedicationRequest-example.html\">MedicationRequest: status = active; intent = order; medication[x] = ->Medication alemtuzumab 10 MG/ML [Lemtrada]; authoredOn = 2015-03-25 19:32:52-0500</a></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td><td><a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/icd-10-cm H44.23}\">H44.23</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-example.html\">Coverage: identifier = Member Number; status = active; type = Other Private Insurance; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23; order = 9</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice glasses}\">glasses</span></p><p><b>serviced</b>: 2014-08-16</p><h3>UnitPrices</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>214.00</td><td>United States dollar</td></tr></table><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice frame}\">frame</span></p><h3>UnitPrices</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>100.00</td><td>United States dollar</td></tr></table><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>100.00</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice lens}\">lens</span></p><p><b>quantity</b>: 2</p><h3>UnitPrices</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>50.00</td><td>United States dollar</td></tr></table><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>100.00</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: <span title=\"Codes:{http://example.org/fhir/CodeSystem/ex-visionservice fst}\">fst</span></p><h3>UnitPrices</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>200.00</td><td>United States dollar</td></tr></table><p><b>factor</b>: 0.07</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>14.00</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"
},
"identifier" : [
{
"system" : "http://happysight.com/claim",
"value" : "6612346"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "vision"
}
]
},
"use" : "claim",
"patient" : {
🔗 "reference" : "Patient/example"
},
"created" : "2014-08-16",
"insurer" : {
🔗 "reference" : "Organization/example"
},
"provider" : {
🔗 "reference" : "Practitioner/example"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"prescription" : {
🔗 "reference" : "MedicationRequest/example"
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/payeetype",
"code" : "provider"
}
]
},
"party" : {
🔗 "reference" : "Practitioner/example"
}
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
🔗 "reference" : "Practitioner/example"
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/icd-10-cm",
"code" : "H44.23"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
🔗 "reference" : "Coverage/example"
}
}
],
"item" : [
{
"sequence" : 1,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "glasses"
}
]
},
"servicedDate" : "2014-08-16",
"unitPrice" : {
"value" : 214.00,
"currency" : "USD"
},
"detail" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "frame"
}
]
},
"unitPrice" : {
"value" : 100.00,
"currency" : "USD"
},
"net" : {
"value" : 100.00,
"currency" : "USD"
}
},
{
"sequence" : 2,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "lens"
}
]
},
"quantity" : {
"value" : 2
},
"unitPrice" : {
"value" : 50.00,
"currency" : "USD"
},
"net" : {
"value" : 100.00,
"currency" : "USD"
}
},
{
"sequence" : 3,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/ex-visionservice",
"code" : "fst"
}
]
},
"unitPrice" : {
"value" : 200.00,
"currency" : "USD"
},
"factor" : 0.07,
"net" : {
"value" : 14.00,
"currency" : "USD"
}
}
]
}
]
}
IG © 2019+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.qicore#7.0.0-ballot based on FHIR 4.0.1. Generated 2024-08-12
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