QI-Core Implementation Guide
5.0.0 - STU5
QI-Core Implementation Guide
5.0.0 - STU5
This page is part of the Quality Improvement Core Framework (v5.0.0: STU5 (v5.0.0)) based on FHIR R4. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions 
Resource Claim "example"
Profile: QICore Claim
identifier: id: 6612346
status: active
type: Vision (Claim Type Codes#vision)
use: claim
patient: Patient/example " CHALMERS"
created: 2014-08-16
insurer: Organization/example "Health Level Seven International"
provider: Practitioner/example " CAREFUL"
priority: Normal (Process Priority Codes#normal)
prescription: MedicationRequest/example
| - | Type | Party |
| * | Provider (Claim Payee Type Codes#provider) | Practitioner/example " CAREFUL" |
| - | Sequence | Provider |
| * | 1 | Practitioner/example " CAREFUL" |
| - | Sequence | Diagnosis[x] |
| * | 1 | 654321 (CodeSystem#654321) |
| - | Sequence | Focal | Coverage |
| * | 1 | true | Coverage/example |
item
sequence: 1
careTeamSequence: 1
productOrService: glasses (ex-visionservice#glasses)
serviced: 2014-08-16
UnitPrices
- Value Currency * 214.00 USD detail
sequence: 1
productOrService: frame (ex-visionservice#frame)
UnitPrices
- Value Currency * 100.00 USD Nets
- Value Currency * 100.00 USD detail
sequence: 2
productOrService: lens (ex-visionservice#lens)
quantity: 2
UnitPrices
- Value Currency * 50.00 USD Nets
- Value Currency * 100.00 USD detail
sequence: 3
productOrService: fst (ex-visionservice#fst)
UnitPrices
- Value Currency * 200.00 USD factor: 0.07
Nets
- Value Currency * 14.00 USD
IG © 2019+ http://www.hl7.org/Special/committees/cqi/index.cfm. Package hl7.fhir.us.qicore#5.0.0 based on FHIR 4.0.1. Generated 2023-04-04
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QA Report
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