QI-Core Implementation Guide
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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

: ClaimResponse example - TTL Representation

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@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:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "example"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claimresponse>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse example</b></p><a name=\"example\"> </a><a name=\"hcexample\"> </a><a name=\"example-en-US\"> </a><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>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jim Chalmers  Male, DoB: 1974-12-25 ( Medical record number (use: usual, period: 2001-05-06 --&gt; (ongoing)))</a></p><p><b>created</b>: 2018-02-24</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization Health Level Seven International</a></p><p><b>requestor</b>: <a href=\"Practitioner-example.html\">Practitioner Adam Careful </a></p><p><b>request</b>: <a href=\"Claim-example.html\">Claim: identifier = http://happysight.com/claim#6612346; status = active; type = Vision; use = claim; created = 2014-08-16; priority = Normal</a></p><p><b>outcome</b>: Queued</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</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>235.40</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"
  ] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
fhir:code [ fhir:v "vision" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
fhir:reference [ fhir:v "Patient/example" ]
  ] ; # 
  fhir:created [ fhir:v "2018-02-24"^^xsd:date] ; # 
  fhir:insurer [
fhir:reference [ fhir:v "Organization/example" ]
  ] ; # 
  fhir:requestor [
fhir:reference [ fhir:v "Practitioner/example" ]
  ] ; # 
  fhir:request [
fhir:reference [ fhir:v "Claim/example" ]
  ] ; # 
  fhir:outcome [ fhir:v "queued"] ; # 
  fhir:item ( [
fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    ( fhir:adjudication [
fhir:category [
        ( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ] ;
fhir:code [ fhir:v "submitted" ]         ] )       ] ;
fhir:amount [
fhir:value [ fhir:v "235.40"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ]       ]     ] )
  ] ) . #