DSTU2 Ballot Source

This page is part of the FHIR Specification (v0.5.0: DSTU 2 Ballot 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Claim-example-vision.json

Raw JSON (canonical form)

Simple Vision Claim

{
  "resourceType": "Claim",
  "id": "660150",
  "text": {
    "status": "generated",
    "div": "<div>!-- Snipped for Brevity --></div>"
  },
  "type": "vision",
  "identifier": [
    {
      "system": "http://happysight.com/claim",
      "value": "6612345"
    }
  ],
  "created": "2014-08-16",
  "target": {
    "reference": "Organization/2"
  },
  "organization": {
    "reference": "Organization/1"
  },
  "use": "complete",
  "priority": {
    "code": "normal"
  },
  "payee": {
    "type": {
      "code": "provider"
    }
  },
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosis": {
        "code": "654321"
      }
    }
  ],
  "patient": {
    "reference": "Patient/1"
  },
  "coverage": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"
      },
      "relationship": {
        "code": "self"
      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "type": {
        "code": "service"
      },
      "provider": {
        "reference": "Practitioner/1"
      },
      "service": {
        "system": "http://hl7.org/fhir/ex-visionservice",
        "code": "exam"
      },
      "serviceDate": "2014-08-16",
      "unitPrice": {
        "value": 80.00,
        "system": "urn:std:iso:4217",
        "code": "USD"
      },
      "net": {
        "value": 80.00,
        "system": "urn:std:iso:4217",
        "code": "USD"
      }
    }
  ]
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.