Claim-example-professional.xml

Simple Pharmacy Service Claim (id = "860150")

<Claim xmlns="http://hl7.org/fhir">
 <id value="860150"/> 

  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Claim</div> 
  </text> 

  <identifier> 
    <system value="http://happypdocs.com/claim"/> 
    <value value="8612345"/> 
  </identifier> 
 
  <status value="active"/> 

  <type> 
   <coding> 
    <system value="http://hl7.org/fhir/ex-claimtype"/> 
    <code value="professional"/> 
   </coding>   
  </type> 
  
  <use value="complete"/> 

  <patient> 
    <reference value="Patient/1"/> 
  </patient> 
 
  <created value="2014-08-16"/> 

  <insurer> 
    <reference value="Organization/2"/> 
  </insurer> 

  <organization> 
    <reference value="Organization/1"/> 
  </organization> 

  <priority> 
   <coding> 
    <code value="normal"/> 
   </coding> 
  </priority> 

  <payee> 
    <type> 
   <coding> 
      <code value="provider"/> 
   </coding> 
    </type> 
  </payee> 

   <careTeam> 
     <sequence value="1"/> 
     <provider> 
       <reference value="Practitioner/example"/> 
     </provider> 
   </careTeam> 
  
  <diagnosis> 
    <sequence value="1"/> 
  <diagnosisCodeableConcept> 
   <coding> 
    <code value="654456"/> 
   </coding> 
  </diagnosisCodeableConcept> 
  </diagnosis> 
 
  <insurance> 
   <sequence value="1"/> 
   <focal value="true"/> 
   <coverage> 
     <reference value="Coverage/9876B1"/> 
   </coverage> 
  </insurance> 
  
  <item> 
   <sequence value="1"/> 
   <careTeamSequence value="1"/> 
   <service> 
    <coding> 
     <system value="http://hl7.org/fhir/ex-serviceproduct"/> 
     <code value="exam"/>  
    </coding> 
   </service> 
   <servicedDate value="2014-08-16"/> 
   <unitPrice> 
      <value value="75.00"/> 
    <system value="urn:iso:std:iso:4217"/> 
      <code value="USD"/>  
   </unitPrice>  
   <net> 
      <value value="75.00"/> 
    <system value="urn:iso:std:iso:4217"/> 
      <code value="USD"/>  
   </net>  
  </item> 

</Claim>