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 
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
Claim number
| label: | |
| system: | |
| value: |
| Current specification followed |
| Original specification followed |
| Creation date |
| Insurer |
|
| Responsible provider |
|
| Responsible organization |
|
| use |
| Desired processing priority |
| Funds requested to be reserved |
| Author |
|
| Servicing Facility |
|
| xml:id (or equivalent in JSON) |
| Party to be paid any benefits payable |
| Provider who is the payee |
|
| Organization who is the payee |
|
| Other person who is the payee |
|
| Treatment Referral |
|
| xml:id (or equivalent in JSON) |
| Sequence of diagnosis |
| Patient's list of diagnosis |
| List of presenting Conditions |
| The subject of the Products and Services |
|
| xml:id (or equivalent in JSON) |
| Service instance identifier |
| Is the focal Coverage |
| Insurance information |
|
| Business agreement |
| Patient relationship to subscriber |
| Pre-Authorization/Determination Reference |
| Adjudication results |
|
| Original version |
| Eligibility exceptions |
| Name of School |
| Accident Date |
| Accident Type |
| Intervention and exception code (Pharma) |
| xml:id (or equivalent in JSON) |
| Service instance |
| Group or type of product or service |
| Responsible practitioner |
|
| Diagnosis Link |
| Item Code |
| Date of Service |
Count of Products or Services
| comp: | |
| value: | |
| units: | |
| coded units: | |
| units system: |
Fee, charge or cost per point
| value: | |
| currency: |
| Price scaling factor |
| Difficulty scaling factor |
Total item cost
| value: | |
| currency: |
| Unique Device Identifier |
| Service Location |
| Service Sub-location |
| Service/Product billing modifiers |
| xml:id (or equivalent in JSON) |
| Service instance |
| Group or type of product or service |
| Additional item codes |
Count of Products or Services
| comp: | |
| value: | |
| units: | |
| coded units: | |
| units system: |
Fee, charge or cost per point
| value: | |
| currency: |
| Price scaling factor |
| Difficulty scaling factor |
Total additional item cost
| value: | |
| currency: |
| Unique Device Identifier |
| xml:id (or equivalent in JSON) |
| Service instance |
| Type of product or service |
| Additional item codes |
Count of Products or Services
| comp: | |
| value: | |
| units: | |
| coded units: | |
| units system: |
Fee, charge or cost per point
| value: | |
| currency: |
| Price scaling factor |
| Difficulty scaling factor |
Net additional item cost
| value: | |
| currency: |
| Unique Device Identifier |
| Additional materials, documents, etc. |
© HL7.org 2011+. FHIR DSTU (v0.4.0-4167) generated on Mon, Feb 23, 2015 09:23+1100.
Links: What's a DSTU? |
Version History |
Compare to DSTU1 |
|
Propose a change
© HL7.org 2011+. FHIR DSTU (v0.4.0-4167) generated on Mon, Feb 23, 2015 09:23+1100.
Links: What's a DSTU? |
Version History |
Compare to DSTU1 |
|
Propose a change