QI-Core Implementation Guide
4.1.1 - STU 4.1.1 US

This page is part of the Quality Improvement Core Framework (v4.1.1: STU 4) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Claim 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:Claim;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "example"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"example\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-qicore-claim.html\">QICoreClaim</a></p></div><p><b>identifier</b>: id: 6612346</p><p><b>status</b>: active</p><p><b>type</b>: Vision <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-claim-type.html\">Claim Type Codes</a>#vision)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-example.html\">Patient/example</a> \" CHALMERS\"</p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <a href=\"Organization-example.html\">Organization/example</a> \"Health Level Seven International\"</p><p><b>provider</b>: <a href=\"Practitioner-example.html\">Practitioner/example</a> \" CAREFUL\"</p><p><b>priority</b>: Normal <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-processpriority.html\">Process Priority Codes</a>#normal)</span></p><p><b>prescription</b>: <a href=\"MedicationRequest-example.html\">MedicationRequest/example</a></p><h3>Payees</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td>*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.1.0/CodeSystem-payeetype.html\">ClaimPayeeTypeCodes</a>#provider)</span></td><td><a href=\"Practitioner-example.html\">Practitioner/example</a> \" CAREFUL\"</td></tr></table><h3>CareTeams</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Provider</b></td></tr><tr><td>*</td><td>1</td><td><a href=\"Practitioner-example.html\">Practitioner/example</a> \" CAREFUL\"</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td></tr><tr><td>*</td><td>1</td><td>654321 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CodeSystem#654321)</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><a href=\"Coverage-example.html\">Coverage/example</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>: glasses <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#glasses)</span></p><p><b>serviced</b>: 2014-08-16</p><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: frame <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#frame)</span></p></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: lens <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#lens)</span></p><p><b>quantity</b>: 2</p></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: fst <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (ex-visionservice#fst)</span></p><p><b>factor</b>: 0.07</p></blockquote></blockquote></div>"
  ];
  fhir:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://happysight.com/claim" ];
     fhir:Identifier.value [ fhir:value "6612346" ]
  ];
  fhir:Claim.status [ fhir:value "active"];
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "vision" ]     ]
  ];
  fhir:Claim.use [ fhir:value "claim"];
  fhir:Claim.patient [
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ];
  fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:Claim.insurer [
     fhir:Reference.reference [ fhir:value "Organization/example" ]
  ];
  fhir:Claim.provider [
     fhir:Reference.reference [ fhir:value "Practitioner/example" ]
  ];
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ];
       fhir:Coding.code [ fhir:value "normal" ]     ]
  ];
  fhir:Claim.prescription [
     fhir:Reference.reference [ fhir:value "MedicationRequest/example" ]
  ];
  fhir:Claim.payee [
     fhir:Claim.payee.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ];
         fhir:Coding.code [ fhir:value "provider" ]       ]     ];
     fhir:Claim.payee.party [
       fhir:Reference.reference [ fhir:value "Practitioner/example" ]     ]
  ];
  fhir:Claim.careTeam [
     fhir:index 0;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.careTeam.provider [
       fhir:Reference.reference [ fhir:value "Practitioner/example" ]     ]
  ];
  fhir:Claim.diagnosis [
     fhir:index 0;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/diagnosis/CodeSystem" ];
         fhir:Coding.code [ fhir:value "654321" ]       ]     ]
  ];
  fhir:Claim.insurance [
     fhir:index 0;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.insurance.coverage [
       fhir:Reference.reference [ fhir:value "Coverage/example" ]     ]
  ];
  fhir:Claim.item [
     fhir:index 0;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
         fhir:Coding.code [ fhir:value "glasses" ]       ]     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "214.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]     ];
     fhir:Claim.item.detail [
       fhir:index 0;
       fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
           fhir:Coding.code [ fhir:value "frame" ]         ]       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "100.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "100.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ], [
       fhir:index 1;
       fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
           fhir:Coding.code [ fhir:value "lens" ]         ]       ];
       fhir:Claim.item.detail.quantity [
         fhir:Quantity.value [ fhir:value "2"^^xsd:decimal ]       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "50.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "100.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ], [
       fhir:index 2;
       fhir:Claim.item.detail.sequence [ fhir:value "3"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/ex-visionservice" ];
           fhir:Coding.code [ fhir:value "fst" ]         ]       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "200.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ];
       fhir:Claim.item.detail.factor [ fhir:value "0.07"^^xsd:decimal ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "14.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]       ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.