This page is part of the Quality Improvement Core Framework (v2.0.0: STU 2) based on FHIR R3. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Claim-qicore-claim-example

Formats: XML, JSON, Turtle

id: example

identifier: 6612346

type: vision

use: complete

​ patient: Patient/example

​ insurer: Organization/example

​ organization: Organization/example

priority: normal

​ prescription: MedicationRequest/example

​ payee: Practitioner/example

​ careTeam: Practitioner/example

diagnosis: 654321

​ insurance: Coverage/example

item

service: glasses

unitPrice: 214.00

net: 214.00

detail 1

service: frame

unitPrice: 100.00

net: 100.00

detail 2

service: lens

unitPrice: 50.00

net: 100.00

detail 3

service: fst

unitPrice: 200.00

factor: 0.07

net: 14.00