2nd DSTU Draft For Comment
This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
Example Index:
| Simple dental Claim | XML | JSON |
| Average dental Claim | XML | JSON |
| SOA dental Claim | XML | JSON |
XML
Simple dental Claim (id = "100150")
<OralHealthClaim xmlns="http://hl7.org/fhir"> <id value="100150"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div> </text> <identifier> <system value="http://happyvalley.com/claims"/> <value value="12345"/> </identifier> <created value="2014-08-16"/> <target> <reference value="Organization/2"/> </target> <organization> <reference value="Organization/1"/> </organization> <use value="complete"/> <priority> <code value="normal"/> </priority> <payee> <type> <code value="provider"/> </type> </payee> <diagnosis> <sequence value="1"/> <diagnosis> <code value="123456"/> </diagnosis> </diagnosis> <patient> <reference value="Patient/1"/> </patient> <coverage> <sequence value="1"/> <focal value="true"/> <coverage> <reference value="Coverage/9876B1"/> </coverage> <relationship> <code value="self"/> </relationship> </coverage> <item> <sequence value="1"/> <type> <code value="service"/> </type> <provider> <reference value="Practitioner/1"/> </provider> <service> <code value="1200"/> </service> <serviceDate value="2014-08-16"/> <unitPrice> <value value="135.57"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="135.57"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </net> </item> </OralHealthClaim>
JSON
Simple dental Claim
{
"resourceType": "OralHealthClaim",
"id": "100150",
"text": {
"status": "generated",
"div": "<div>!-- Snipped for Brevity --></div>"
},
"identifier": [
{
"system": "http://happyvalley.com/claims",
"value": "12345"
}
],
"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": "123456"
}
}
],
"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": {
"code": "1200"
},
"serviceDate": "2014-08-16",
"unitPrice": {
"value": 135.57,
"system": "urn:std:iso:4217",
"code": "USD"
},
"net": {
"value": 135.57,
"system": "urn:std:iso:4217",
"code": "USD"
}
}
]
}
XML
Average dental Claim (id = "100151")
<OralHealthClaim xmlns="http://hl7.org/fhir"> <id value="100151"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div> </text> <identifier> <system value="http://happyvalley.com/claims"/> <value value="12346"/> </identifier> <created value="2014-08-16"/> <target> <reference value="Organization/2"/> </target> <organization> <reference value="Organization/1"/> </organization> <use value="complete"/> <priority> <code value="normal"/> </priority> <payee> <type> <code value="provider"/> </type> </payee> <diagnosis> <sequence value="1"/> <diagnosis> <code value="123456"/> </diagnosis> </diagnosis> <patient> <reference value="Patient/1"/> </patient> <coverage> <sequence value="1"/> <focal value="true"/> <coverage> <reference value="Coverage/9876B1"/> </coverage> <relationship> <code value="self"/> </relationship> </coverage> <item> <sequence value="1"/> <type> <code value="service"/> </type> <provider> <reference value="Practitioner/1"/> </provider> <service> <system value="http://hl7.org/fhir/oralservicecodes"/> <code value="1200"/> </service> <serviceDate value="2014-08-16"/> <unitPrice> <value value="135.57"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="135.57"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </net> </item> <item> <sequence value="2"/> <type> <code value="service"/> </type> <provider> <reference value="Practitioner/1"/> </provider> <service> <system value="http://hl7.org/fhir/oralservicecodes"/> <code value="21211"/> </service> <serviceDate value="2014-08-16"/> <unitPrice> <value value="105.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="105.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </net> <bodySite> <system value="http://fdi.org/fhir/oraltoothcodes"/> <code value="21"/> </bodySite> <subsite> <system value="http://fdi.org/fhir/oralsurfacecodes"/> <code value="L"/> </subsite> </item> <item> <sequence value="3"/> <type> <code value="group"/> </type> <provider> <reference value="Practitioner/1"/> </provider> <service> <system value="http://hl7.org/fhir/oralservicecodes"/> <code value="27211"/> </service> <serviceDate value="2014-08-16"/> <unitPrice> <value value="1100.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="1100.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </net> <bodySite> <system value="http://fdi.org/fhir/oraltoothcodes"/> <code value="36"/> </bodySite> <detail> <sequence value="1"/> <type> <code value="service"/> </type> <service> <system value="http://hl7.org/fhir/oralservicecodes"/> <code value="27211"/> </service> <unitPrice> <value value="750.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="750.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </net> </detail> <detail> <sequence value="2"/> <type> <code value="service"/> </type> <service> <system value="http://hl7.org/fhir/oralservicecodes"/> <code value="lab"/> </service> <unitPrice> <value value="350.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="350.00"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </net> </detail> </item> </OralHealthClaim>
JSON
Average dental Claim
{
"resourceType": "OralHealthClaim",
"id": "100151",
"text": {
"status": "generated",
"div": "<div>!-- Snipped for Brevity --></div>"
},
"identifier": [
{
"system": "http://happyvalley.com/claims",
"value": "12346"
}
],
"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": "123456"
}
}
],
"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/oralservicecodes",
"code": "1200"
},
"serviceDate": "2014-08-16",
"unitPrice": {
"value": 135.57,
"system": "urn:std:iso:4217",
"code": "USD"
},
"net": {
"value": 135.57,
"system": "urn:std:iso:4217",
"code": "USD"
}
},
{
"sequence": 2,
"type": {
"code": "service"
},
"provider": {
"reference": "Practitioner/1"
},
"service": {
"system": "http://hl7.org/fhir/oralservicecodes",
"code": "21211"
},
"serviceDate": "2014-08-16",
"unitPrice": {
"value": 105.00,
"system": "urn:std:iso:4217",
"code": "USD"
},
"net": {
"value": 105.00,
"system": "urn:std:iso:4217",
"code": "USD"
},
"bodySite": {
"system": "http://fdi.org/fhir/oraltoothcodes",
"code": "21"
},
"subsite": [
{
"system": "http://fdi.org/fhir/oralsurfacecodes",
"code": "L"
}
]
},
{
"sequence": 3,
"type": {
"code": "group"
},
"provider": {
"reference": "Practitioner/1"
},
"service": {
"system": "http://hl7.org/fhir/oralservicecodes",
"code": "27211"
},
"serviceDate": "2014-08-16",
"unitPrice": {
"value": 1100.00,
"system": "urn:std:iso:4217",
"code": "USD"
},
"net": {
"value": 1100.00,
"system": "urn:std:iso:4217",
"code": "USD"
},
"bodySite": {
"system": "http://fdi.org/fhir/oraltoothcodes",
"code": "36"
},
"detail": [
{
"sequence": 1,
"type": {
"code": "service"
},
"service": {
"system": "http://hl7.org/fhir/oralservicecodes",
"code": "27211"
},
"unitPrice": {
"value": 750.00,
"system": "urn:std:iso:4217",
"code": "USD"
},
"net": {
"value": 750.00,
"system": "urn:std:iso:4217",
"code": "USD"
}
},
{
"sequence": 2,
"type": {
"code": "service"
},
"service": {
"system": "http://hl7.org/fhir/oralservicecodes",
"code": "lab"
},
"unitPrice": {
"value": 350.00,
"system": "urn:std:iso:4217",
"code": "USD"
},
"net": {
"value": 350.00,
"system": "urn:std:iso:4217",
"code": "USD"
}
}
]
}
]
}
XML
SOA dental Claim (id = "100152")
<OralHealthClaim xmlns="http://hl7.org/fhir"> <id value="100152"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div> </text> <contained> <Organization> <id value="organization-1"/> <identifier> <system value="http://www.jurisdiction.com/oralhealthoffices"/> <value value="3456"/> </identifier> </Organization> </contained> <contained> <Organization> <id value="organization-2"/> <identifier> <system value="http://www.bindb.com/bin"/> <value value="123456"/> </identifier> </Organization> </contained> <contained> <Practitioner> <id value="practitioner-1"/> <identifier> <system value="http://www.jurisdiction.com/oralhealthproviders"/> <value value="123456789"/> </identifier> </Practitioner> </contained> <contained> <Patient> <id value="patient-1"/> <name> <use value="official"/> <family value="Donald"/> <given value="Duck"/> </name> <gender value="male"/> <birthDate value="1986-05-17"/> <address> <use value="home"/> <line value="1234 Main Street"/> <city value="Vancouver"/> <postalCode value="V2H1Y3"/> <country value="CAD"/> </address> </Patient> </contained> <contained> <Coverage> <id value="coverage-1"/> <issuer> <reference value="#organization-2"/> </issuer> <type> <system value="http://hl7.org/fhir/v3/ActCode"/> <code value="EHCPOL"/> </type> <identifier> <system value="http://benefitsinc.com/certificate"/> <value value="12345"/> </identifier> <plan value="CBI35"/> <subplan value="123"/> <dependent value="0"/> <sequence value="1"/> <subscriber> <reference value="#patient-1"/> </subscriber> </Coverage> </contained> <identifier> <system value="http://happyvalley.com/claims"/> <value value="12347"/> </identifier> <created value="2014-08-16"/> <target> <reference value="#organization-2"/> </target> <organization> <reference value="#organization-1"/> </organization> <use value="complete"/> <priority> <code value="normal"/> </priority> <payee> <type> <code value="provider"/> </type> </payee> <diagnosis> <sequence value="1"/> <diagnosis> <code value="123456"/> </diagnosis> </diagnosis> <patient> <reference value="#patient-1"/> </patient> <coverage> <sequence value="1"/> <focal value="true"/> <coverage> <reference value="#coverage-1"/> </coverage> <relationship> <code value="self"/> </relationship> </coverage> <item> <sequence value="1"/> <type> <code value="service"/> </type> <provider> <reference value="#practitioner-1"/> </provider> <service> <code value="1200"/> </service> <serviceDate value="2014-08-16"/> <unitPrice> <value value="135.57"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </unitPrice> <net> <value value="135.57"/> <system value="urn:std:iso:4217"/> <code value="USD"/> </net> </item> </OralHealthClaim>
JSON
SOA dental Claim
{
"resourceType": "OralHealthClaim",
"id": "100152",
"text": {
"status": "generated",
"div": "<div>!-- Snipped for Brevity --></div>"
},
"contained": [
{
"resourceType": "Organization",
"id": "organization-1",
"identifier": [
{
"system": "http://www.jurisdiction.com/oralhealthoffices",
"value": "3456"
}
]
},
{
"resourceType": "Organization",
"id": "organization-2",
"identifier": [
{
"system": "http://www.bindb.com/bin",
"value": "123456"
}
]
},
{
"resourceType": "Practitioner",
"id": "practitioner-1",
"identifier": [
{
"system": "http://www.jurisdiction.com/oralhealthproviders",
"value": "123456789"
}
]
},
{
"resourceType": "Patient",
"id": "patient-1",
"name": [
{
"use": "official",
"family": [
"Donald"
],
"given": [
"Duck"
]
}
],
"gender": "male",
"birthDate": "1986-05-17",
"address": [
{
"use": "home",
"line": [
"1234 Main Street"
],
"city": "Vancouver",
"postalCode": "V2H1Y3",
"country": "CAD"
}
]
},
{
"resourceType": "Coverage",
"id": "coverage-1",
"issuer": {
"reference": "#organization-2"
},
"type": {
"system": "http://hl7.org/fhir/v3/ActCode",
"code": "EHCPOL"
},
"identifier": [
{
"system": "http://benefitsinc.com/certificate",
"value": "12345"
}
],
"plan": "CBI35",
"subplan": "123",
"dependent": 0,
"sequence": 1,
"subscriber": {
"reference": "#patient-1"
}
}
],
"identifier": [
{
"system": "http://happyvalley.com/claims",
"value": "12347"
}
],
"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": "123456"
}
}
],
"patient": {
"reference": "#patient-1"
},
"coverage": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "#coverage-1"
},
"relationship": {
"code": "self"
}
}
],
"item": [
{
"sequence": 1,
"type": {
"code": "service"
},
"provider": {
"reference": "#practitioner-1"
},
"service": {
"code": "1200"
},
"serviceDate": "2014-08-16",
"unitPrice": {
"value": 135.57,
"system": "urn:std:iso:4217",
"code": "USD"
},
"net": {
"value": 135.57,
"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.
© HL7.org 2011+. FHIR DSTU (v0.4.0-4167) generated on Mon, Feb 23, 2015 09:22+1100.
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