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
This is an example form generated from the questionnaire. See also the XML or JSON format.
This is an example form generated from the questionnaire. See also the XML or JSON format
Logical id of this artefact |
Metadata about the resource
A set of rules under which this content was created |
language |
Text summary of the resource, for human interpretation
Contained, inline Resources
Business Identifier
label: | |
system: | |
value: |
Claim reference |
|
outcome |
Disposition Message |
Resource version |
Original version |
Creation date |
Period covered
start: | |
end: |
Insurer |
|
Responsible practitioner |
|
Responsible organization |
|
xml:id (or equivalent in JSON) |
Type code |
Claim |
|
Claim Response |
|
Submitter |
|
Payee |
|
Invoice date |
Detail amount
value: | |
currency: |
Printed Form Identifier |
Total amount of Payment
value: | |
currency: |
xml:id (or equivalent in JSON) |
display | print | printoper |
Notes text |