This page is part of the Quality Improvement Core Framework (v6.0.0: STU6 (v6.0.0)) based on FHIR (HL7® FHIR® Standard) 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
@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:id [ fhir:v "example"] ; #
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-claim> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Claim</b><a name=\"example\"> </a></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 Claim "example" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-qicore-claim.html\">QICore Claim</a></p></div><p><b>identifier</b>: <code>http://happysight.com/claim</code>/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/5.4.0/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/5.4.0/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 style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td>Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.4.0/CodeSystem-payeetype.html\">Payee Type Codes</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 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/example</a> " CAREFUL"</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>H44.23 <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (icd-10-cm#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/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><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>USD</td></tr></table><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><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>USD</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>USD</td></tr></table></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><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>USD</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>USD</td></tr></table></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><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>USD</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>USD</td></tr></table></blockquote></blockquote></div>"
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "http://happysight.com/claim"^^xsd:anyURI ] ;
fhir:value [ fhir:v "6612346" ]
] ) ; #
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 "claim"] ; #
fhir:patient [
fhir:reference [ fhir:v "Patient/example" ]
] ; #
fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; #
fhir:insurer [
fhir:reference [ fhir:v "Organization/example" ]
] ; #
fhir:provider [
fhir:reference [ fhir:v "Practitioner/example" ]
] ; #
fhir:priority [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
fhir:code [ fhir:v "normal" ] ] )
] ; #
fhir:prescription [
fhir:reference [ fhir:v "MedicationRequest/example" ]
] ; #
fhir:payee [
fhir:type [
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ] ;
fhir:code [ fhir:v "provider" ] ] ) ] ;
fhir:party [
fhir:reference [ fhir:v "Practitioner/example" ] ]
] ; #
fhir:careTeam ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:provider [
fhir:reference [ fhir:v "Practitioner/example" ] ]
] ) ; #
fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:CodeableConcept ;
( fhir:coding [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/icd-10-cm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "H44.23" ] ] ) ]
] ) ; #
fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v "true"^^xsd:boolean ] ;
fhir:coverage [
fhir:reference [ fhir:v "Coverage/example" ] ]
] ) ; #
fhir:item ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
( fhir:careTeamSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
( fhir:coding [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "glasses" ] ] ) ] ;
fhir:serviced [ fhir:v "2014-08-16"^^xsd:date ] ;
fhir:unitPrice [
fhir:value [ fhir:v "214.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ;
( fhir:detail [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:productOrService [
( fhir:coding [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "frame" ] ] ) ] ;
fhir:unitPrice [
fhir:value [ fhir:v "100.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ;
fhir:net [
fhir:value [ fhir:v "100.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] [
fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:productOrService [
( fhir:coding [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "lens" ] ] ) ] ;
fhir:quantity [
fhir:value [ fhir:v "2"^^xsd:decimal ] ] ;
fhir:unitPrice [
fhir:value [ fhir:v "50.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ;
fhir:net [
fhir:value [ fhir:v "100.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] [
fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
fhir:productOrService [
( fhir:coding [
fhir:system [ fhir:v "http://example.org/fhir/CodeSystem/ex-visionservice"^^xsd:anyURI ] ;
fhir:code [ fhir:v "fst" ] ] ) ] ;
fhir:unitPrice [
fhir:value [ fhir:v "200.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ;
fhir:factor [ fhir:v "0.07"^^xsd:decimal ] ;
fhir:net [
fhir:value [ fhir:v "14.00"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] )
] ) . #
IG © 2019+ HL7 International / Clinical Quality Information. Package hl7.fhir.us.qicore#6.0.0 based on FHIR 4.0.1. Generated 2024-03-01
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