This page is part of the Quality Improvement Core Framework (v3.1.0: STU 3) based on FHIR R3. The current version which supercedes this version is 4.1.1. For a full list of available versions, see the Directory of published versions

Example: Claim-example

Formats: Narrative, XML, JSON, Turtle

Generated Narrative with Details

id: example

meta:

identifier: 6612346

status: active

type: Vision (Details : {http://hl7.org/fhir/ex-claimtype code 'vision' = 'Vision)

use: complete

patient: Generated Summary: id: example; Medical record number = 12345 (USUAL); active; Peter James Chalmers (OFFICIAL), Jim Chalmers , Peter James Windsor (MAIDEN); -unknown-(HOME), ph: (03) 5555 6473(WORK), ph: (03) 3410 5613(MOBILE), ph: (03) 5555 8834(OLD); gender: male; birthDate: 25/12/1974;

created: 16/08/2014

insurer: Generated Summary: id: example; ??; active; Organizational team; name: Health Level Seven International; ph: (+1) 734-677-7777, fax: (+1) 734-677-6622, hq@HL7.org

provider: Generated Summary: id: example; 23; active; Adam Careful

organization: Generated Summary: id: example; ??; active; Organizational team; name: Health Level Seven International; ph: (+1) 734-677-7777, fax: (+1) 734-677-6622, hq@HL7.org

priority: normal (Details : {[not stated] code 'normal' = 'normal)

prescription: Generated Summary: id: example; status: active; intent: order; ????; authoredOn: 25/03/2015 7:32:52 PM;

Payees

-TypeParty
*provider (Details : {[not stated] code 'provider' = 'provider)Generated Summary: id: example; 23; active; Adam Careful

CareTeams

-SequenceProvider
*1Generated Summary: id: example; 23; active; Adam Careful

Diagnoses

-SequenceDiagnosis[x]
*1654321 (Details : {[not stated] code '654321' = '654321)

Insurances

-SequenceFocalCoverage
*1trueGenerated Summary: id: example; 12345; status: active; extended healthcare; self; period: 23/05/2011 12:00:00 AM --> 23/05/2012 12:00:00 AM; dependent: 0; sequence: 9

item

sequence: 1

careTeamLinkId: 1

service: glasses (Details : {http://example.org/fhir/CodeSystem/ex-visionservice code 'glasses' = 'glasses)

serviced: 16/08/2014

unitPrice:

net:

detail

sequence: 1

service: frame (Details : {http://example.org/fhir/CodeSystem/ex-visionservice code 'frame' = 'frame)

unitPrice:

net:

detail

sequence: 2

service: lens (Details : {http://example.org/fhir/CodeSystem/ex-visionservice code 'lens' = 'lens)

quantity: 2

unitPrice:

net:

detail

sequence: 3

service: fst (Details : {http://example.org/fhir/CodeSystem/ex-visionservice code 'fst' = 'fst)

unitPrice:

factor: 0.07

net: