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

7.20.5 Resource VisionClaim - Examples

Example Index:

Simple vision ClaimXMLJSON
Glasses ClaimXMLJSON

7.20.5.1 General-Claim-Simple

XML

Simple vision Claim (id = "660150")

Raw XML

<VisionClaim xmlns="http://hl7.org/fhir">
  <id value="660150"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
  </text>
  <identifier>
    <system value="http://happysight.com/claims"/>
    <value value="6612345"/>
  </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="654321"/>
    </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/ex-visionservice"/>
      <code value="exam"/>
    </service>
    <serviceDate value="2014-08-16"/>
    <unitPrice>
      <value value="80.00"/>
      <system value="urn:std:iso:4217"/>
      <code value="USD"/>
    </unitPrice>
    <net>
      <value value="80.00"/>
      <system value="urn:std:iso:4217"/>
      <code value="USD"/>
    </net>
  </item>
</VisionClaim>

JSON

Simple vision Claim

Raw JSON (Canonical)

{
  "resourceType": "VisionClaim",
  "id": "660150",
  "text": {
    "status": "generated",
    "div": "<div>!-- Snipped for Brevity --></div>"
  },
  "identifier": [
    {
      "system": "http://happysight.com/claims",
      "value": "6612345"
    }
  ],
  "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": "654321"
      }
    }
  ],
  "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/ex-visionservice",
        "code": "exam"
      },
      "serviceDate": "2014-08-16",
      "unitPrice": {
        "value": 80.00,
        "system": "urn:std:iso:4217",
        "code": "USD"
      },
      "net": {
        "value": 80.00,
        "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.