Release 4 FHIR CI-Build

This page is part of the Continuous Integration Build of FHIR Specification (v4.0.1: R4 - Mixed Normative and STU ) in it's permanent home (it will always (will be available incorrect/inconsistent at this URL). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see times).
See the Directory of published versions . Page versions: R5 R4B R4

Claim-example-cms1500-medical.ttl

Example Claim/MED-00050 (Turtle)

Maturity Level : N/A
Responsible Owner: Financial Management Work Group Standards Status : Informative Compartments : Device , Encounter , Group , Patient , Practitioner , RelatedPerson

Raw Turtle (+ also see Turtle/RDF Format Specification )

Simple US Medical Surgery Claim 

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .

@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Claim/MED-00050> a fhir:Claim;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "MED-00050"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of a CMS 1500 Claim</div>"
  ];
  fhir:DomainResource.contained [
     a fhir:Patient;
     fhir:index 0;
     fhir:Resource.id [ fhir:value "patient-1" ];
     fhir:Patient.name [
       fhir:index 0;
       fhir:HumanName.use [ fhir:value "official" ];
       fhir:HumanName.family [ fhir:value "Ashcraft" ];
       fhir:HumanName.given [
         fhir:value "Alvina";
         fhir:index 0
       ]
     ];
     fhir:Patient.gender [ fhir:value "female" ];
     fhir:Patient.birthDate [ fhir:value "1954-06-11"^^xsd:date ];
     fhir:Patient.address [
       fhir:index 0;
       fhir:Address.use [ fhir:value "home" ];
       fhir:Address.line [
         fhir:value "123 Main Street";
         fhir:index 0
       ];
       fhir:Address.city [ fhir:value "Portland" ];
       fhir:Address.state [ fhir:value "OR" ];
       fhir:Address.postalCode [ fhir:value "97125" ];
       fhir:Address.country [ fhir:value "USA" ]
     ]
  ], [
     a fhir:Coverage;
     fhir:index 1;
     fhir:Resource.id [ fhir:value "coverage-1" ];
     fhir:Coverage.identifier [
       fhir:index 0;
       fhir:Identifier.system [ fhir:value "http://benefitsinc.com/certificate" ];
       fhir:Identifier.value [ fhir:value "10138556" ]
     ];
     fhir:Coverage.status [ fhir:value "active" ];
     fhir:Coverage.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
         fhir:Coding.code [ fhir:value "HIP" ];
         fhir:Coding.display [ fhir:value "health insurance plan policy" ]
       ]
     ];
     fhir:Coverage.subscriber [
       fhir:Reference.reference [ fhir:value "#patient-1" ]
     ];
     fhir:Coverage.beneficiary [
       fhir:Reference.reference [ fhir:value "#patient-1" ]
     ];
     fhir:Coverage.relationship [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.code [ fhir:value "self" ]
       ]
     ];
     fhir:Coverage.period [
       fhir:Period.start [ fhir:value "2015-01-01T00:00:00-07:00"^^xsd:dateTime ];
       fhir:Period.end [ fhir:value "2016-01-01T00:00:00-07:00"^^xsd:dateTime ]
     ];
     fhir:Coverage.payor [
       fhir:index 0;
       fhir:Reference.identifier [
         fhir:Identifier.system [ fhir:value "http://www.bindb.com/bin" ];
         fhir:Identifier.value [ fhir:value "123456" ]
       ];
       fhir:Reference.display [ fhir:value "Humana Inc." ]
     ];
     fhir:Coverage.class [
       fhir:index 0;
       fhir:Coverage.class.type [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/coverage-class" ];
           fhir:Coding.code [ fhir:value "group" ]
         ]
       ];
       fhir:Coverage.class.value [ fhir:value "80902206" ]
     ]
  ];
  fhir:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://CedarArmsMedicalCenter.com/claim" ];
     fhir:Identifier.value [ fhir:value "MED-00050" ]
  ];
  fhir:Claim.status [ fhir:value "active"];
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
       fhir:Coding.code [ fhir:value "institutional" ]
     ]
  ];
  fhir:Claim.subType [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "https://www.cms.gov/codes/billtype" ];
       fhir:Coding.code [ fhir:value "831" ];
       fhir:Coding.display [ fhir:value "Hospital Outpatient Surgery performed in an Ambulatory ​Surgical Center" ]
     ]
  ];
  fhir:Claim.use [ fhir:value "claim"];
  fhir:Claim.patient [
     fhir:Reference.reference [ fhir:value "#patient-1" ]
  ];
  fhir:Claim.created [ fhir:value "2015-10-16T00:00:00-07:00"^^xsd:dateTime];
  fhir:Claim.insurer [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "http://www.bindb.com/bin" ];
       fhir:Identifier.value [ fhir:value "123456" ]
     ];
     fhir:Reference.display [ fhir:value "Humana Inc." ]
  ];
  fhir:Claim.provider [
     fhir:link <http://hl7.org/fhir/Organization/1>;
     fhir:Reference.reference [ fhir:value "Organization/1" ]
  ];
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.code [ fhir:value "normal" ]
     ]
  ];
  fhir:Claim.payee [
     fhir:Claim.payee.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ];
         fhir:Coding.code [ fhir:value "provider" ]

<http://hl7.org/fhir/Claim/MED-00050> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "MED-00050"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of a CMS 1500 Claim</div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:contained ( [
     a fhir:Patient ;
     fhir:id [ fhir:v "patient-1" ] ;
     fhir:name ( [
       fhir:use [ fhir:v "official" ] ;
       fhir:family [ fhir:v "Ashcraft" ] ;
       fhir:given ( [ fhir:v "Alvina" ] )
     ] ) ;
     fhir:gender [ fhir:v "female" ] ;
     fhir:birthDate [ fhir:v "1954-06-11"^^xsd:date ] ;
     fhir:address ( [
       fhir:use [ fhir:v "home" ] ;
       fhir:line ( [ fhir:v "123 Main Street" ] ) ;
       fhir:city [ fhir:v "Portland" ] ;
       fhir:state [ fhir:v "OR" ] ;
       fhir:postalCode [ fhir:v "97125" ] ;
       fhir:country [ fhir:v "USA" ]
     ] )
  ] [
     a fhir:Coverage ;
     fhir:id [ fhir:v "coverage-1" ] ;
     fhir:identifier ( [
       fhir:system [
         fhir:v "http://benefitsinc.com/certificate"^^xsd:anyURI ;
         fhir:l <http://benefitsinc.com/certificate>
       ] ;
       fhir:value [ fhir:v "10138556" ]
     ] ) ;
     fhir:status [ fhir:v "active" ] ;
     fhir:kind [ fhir:v "insurance" ] ;
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode>
         ] ;
         fhir:code [ fhir:v "HIP" ] ;
         fhir:display [ fhir:v "health insurance plan policy" ]
       ] )
     ] ;
     fhir:subscriber [
       fhir:l <#patient-1> ;
       fhir:reference [ fhir:v "#patient-1" ]
     ] ;
     fhir:beneficiary [
       fhir:l <#patient-1> ;
       fhir:reference [ fhir:v "#patient-1" ]
     ] ;
     fhir:relationship [
       fhir:coding ( [
         fhir:code [ fhir:v "self" ]
       ] )
     ] ;
     fhir:period [
       fhir:start [ fhir:v "2015-01-01T00:00:00-07:00"^^xsd:dateTime ] ;
       fhir:end [ fhir:v "2016-01-01T00:00:00-07:00"^^xsd:dateTime ]
     ] ;
     fhir:insurer [
       fhir:identifier [
         fhir:system [
           fhir:v "http://www.bindb.com/bin"^^xsd:anyURI ;
           fhir:l <http://www.bindb.com/bin>
         ] ;
         fhir:value [ fhir:v "123456" ]
       ] ;
       fhir:display [ fhir:v "Humana Inc." ]
     ] ;
     fhir:class ( [
       fhir:type [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
             fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class>
           ] ;
           fhir:code [ fhir:v "group" ]
         ] )
       ] ;
       fhir:value [
         fhir:value [ fhir:v "80902206" ]

       ]
     ];
     fhir:Claim.payee.party [
       fhir:link <http://hl7.org/fhir/Organization/1>;
       fhir:Reference.reference [ fhir:value "Organization/1" ]

     ] )
  ] ) ; # 
  fhir:identifier ( [
     fhir:system [
       fhir:v "http://CedarArmsMedicalCenter.com/claim"^^xsd:anyURI ;
       fhir:l <http://CedarArmsMedicalCenter.com/claim>
     ] ;
     fhir:value [ fhir:v "MED-00050" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
     fhir:coding ( [
       fhir:system [
         fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
         fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>
       ] ;
       fhir:code [ fhir:v "institutional" ]
     ] )
  ] ; # 
  fhir:subType [
     fhir:coding ( [
       fhir:system [
         fhir:v "https://www.cms.gov/codes/billtype"^^xsd:anyURI ;
         fhir:l <https://www.cms.gov/codes/billtype>
       ] ;
       fhir:code [ fhir:v "831" ] ;
       fhir:display [ fhir:v "Hospital Outpatient Surgery performed in an Ambulatory ​Surgical Center" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:subject [
     fhir:l <#patient-1> ;
     fhir:reference [ fhir:v "#patient-1" ]
  ] ; # 
  fhir:created [ fhir:v "2015-10-16T00:00:00-07:00"^^xsd:dateTime] ; # 
  fhir:insurer [
     fhir:identifier [
       fhir:system [
         fhir:v "http://www.bindb.com/bin"^^xsd:anyURI ;
         fhir:l <http://www.bindb.com/bin>
       ] ;
       fhir:value [ fhir:v "123456" ]
     ] ;
     fhir:display [ fhir:v "Humana Inc." ]
  ] ; # 
  fhir:provider [
     fhir:l <http://hl7.org/fhir/Organization/1> ;
     fhir:reference [ fhir:v "Organization/1" ]
  ] ; # 
  fhir:priority [
     fhir:coding ( [
       fhir:code [ fhir:v "normal" ]
     ] )
  ] ; # 
  fhir:payee [
     fhir:type [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/payeetype>
         ] ;
         fhir:code [ fhir:v "provider" ]
       ] )
     ] ;
     fhir:party [
       fhir:l <http://hl7.org/fhir/Organization/1> ;
       fhir:reference [ fhir:v "Organization/1" ]

     ]
  ];
  fhir:Claim.careTeam [
     fhir:index 0;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.careTeam.provider [
       fhir:link <http://hl7.org/fhir/Practitioner/example>;
       fhir:Reference.reference [ fhir:value "Practitioner/example" ]

  ] ; # 
  fhir:careTeam ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:provider [
       fhir:l <http://hl7.org/fhir/Practitioner/example> ;
       fhir:reference [ fhir:v "Practitioner/example" ]

     ]
  ];
  fhir:Claim.supportingInfo [
     fhir:index 0;
     fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
         fhir:Coding.code [ fhir:value "hospitalized" ]
       ]
     ];
     fhir:Claim.supportingInfo.timingPeriod [
       fhir:Period.start [ fhir:value "2015-10-01T00:00:00-07:00"^^xsd:dateTime ];
       fhir:Period.end [ fhir:value "2015-10-05T00:00:00-07:00"^^xsd:dateTime ]

  ] ) ; # 
  fhir:supportingInfo ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/claiminformationcategory>
         ] ;
         fhir:code [ fhir:v "hospitalized" ]
       ] )
     ] ;
     fhir:timing [
       a fhir:Period ;
       fhir:start [ fhir:v "2015-10-01T00:00:00-07:00"^^xsd:dateTime ] ;
       fhir:end [ fhir:v "2015-10-05T00:00:00-07:00"^^xsd:dateTime ]

     ]
  ], [
     fhir:index 1;
     fhir:Claim.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ];
         fhir:Coding.code [ fhir:value "discharge" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0801.pdf" ];
         fhir:Coding.code [ fhir:value "01" ];
         fhir:Coding.display [ fhir:value "Discharge to Home or Self Care" ]
       ]

  ] [
     fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
     fhir:category [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/claiminformationcategory>
         ] ;
         fhir:code [ fhir:v "discharge" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [
           fhir:v "https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0801.pdf"^^xsd:anyURI ;
           fhir:l <https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0801.pdf>
         ] ;
         fhir:code [ fhir:v "01" ] ;
         fhir:display [ fhir:v "Discharge to Home or Self Care" ]
       ] )

     ]
  ];
  fhir:Claim.diagnosis [
     fhir:index 0;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ];
         fhir:Coding.code [ fhir:value "M96.1" ];
         fhir:Coding.display [ fhir:value "Postlaminectomy syndrome" ]
       ]

  ] ) ; # 
  fhir:diagnosis ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/sid/icd-10-cm>
         ] ;
         fhir:code [ fhir:v "M96.1" ] ;
         fhir:display [ fhir:v "Postlaminectomy syndrome, not elsewhere classified" ]
       ] )

     ]
  ], [
     fhir:index 1;
     fhir:Claim.diagnosis.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ];
         fhir:Coding.code [ fhir:value "G89.4" ];
         fhir:Coding.display [ fhir:value "Chronic pain syndrome" ]
       ]

  ] [
     fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/sid/icd-10-cm>
         ] ;
         fhir:code [ fhir:v "G89.4" ] ;
         fhir:display [ fhir:v "Chronic pain syndrome" ]
       ] )

     ]
  ], [
     fhir:index 2;
     fhir:Claim.diagnosis.sequence [ fhir:value "3"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ];
         fhir:Coding.code [ fhir:value "M53.88" ];
         fhir:Coding.display [ fhir:value "Other specified dorsopathies, sacral and sacrococcygeal region" ]
       ]

  ] [
     fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/sid/icd-10-cm>
         ] ;
         fhir:code [ fhir:v "M53.88" ] ;
         fhir:display [ fhir:v "Other specified dorsopathies, sacral and sacrococcygeal region" ]
       ] )

     ]
  ], [
     fhir:index 3;
     fhir:Claim.diagnosis.sequence [ fhir:value "4"^^xsd:positiveInteger ];
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10" ];
         fhir:Coding.code [ fhir:value "M47.816" ];
         fhir:Coding.display [ fhir:value "Spondylosis without myelopathy or radiculopathy, lumbar region" ]
       ]

  ] [
     fhir:sequence [ fhir:v "4"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "http://hl7.org/fhir/sid/icd-10-cm"^^xsd:anyURI ;
           fhir:l <http://hl7.org/fhir/sid/icd-10-cm>
         ] ;
         fhir:code [ fhir:v "M47.816" ] ;
         fhir:display [ fhir:v "Spondylosis without myelopathy or radiculopathy, lumbar region" ]
       ] )

     ]
  ];
  fhir:Claim.insurance [
     fhir:index 0;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ];
     fhir:Claim.insurance.identifier [
       fhir:Identifier.system [ fhir:value "http://CedarArmsMedicalCenter.com/claim" ];
       fhir:Identifier.value [ fhir:value "MED-00050" ]
     ];
     fhir:Claim.insurance.coverage [
       fhir:Reference.reference [ fhir:value "#coverage-1" ]

  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v true ] ;
     fhir:identifier [
       fhir:system [
         fhir:v "http://CedarArmsMedicalCenter.com/claim"^^xsd:anyURI ;
         fhir:l <http://CedarArmsMedicalCenter.com/claim>
       ] ;
       fhir:value [ fhir:v "MED-00050" ]
     ] ;
     fhir:coverage [
       fhir:l <#coverage-1> ;
       fhir:reference [ fhir:v "#coverage-1" ]

     ]
  ];
  fhir:Claim.item [
     fhir:index 0;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.diagnosisSequence [
       fhir:value "2"^^xsd:positiveInteger;
       fhir:index 0
     ], [
       fhir:value "4"^^xsd:positiveInteger;
       fhir:index 1
     ];
     fhir:Claim.item.informationSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://www.ama-assn.org/go/cpt" ];
         fhir:Coding.code [ fhir:value "62264" ];
         fhir:Coding.display [ fhir:value "Surgical Procedures on the Spine and Spinal Cord" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2015-10-13"^^xsd:date ];
     fhir:Claim.item.locationCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "https://www.cms.gov/medicare/coding/place-of-service-codes/place_of_service_code_set.html" ];
         fhir:Coding.code [ fhir:value "24" ];
         fhir:Coding.display [ fhir:value "Ambulatory Surgical Center" ]
       ]
     ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "12500.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "12500.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]

  ] ) ; # 
  fhir:item ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:diagnosisSequence ( [ fhir:v "2"^^xsd:positiveInteger ] [ fhir:v "4"^^xsd:positiveInteger ] ) ;
     fhir:informationSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ;
           fhir:l <http://www.ama-assn.org/go/cpt>
         ] ;
         fhir:code [ fhir:v "62264" ] ;
         fhir:display [ fhir:v "Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day" ]
       ] )
     ] ;
     fhir:serviced [
       a fhir:Date ;
       fhir:v "2015-10-13"^^xsd:date
     ] ;
     fhir:location [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:system [
           fhir:v "https://www.cms.gov/medicare/coding/place-of-service-codes/place_of_service_code_set.html"^^xsd:anyURI ;
           fhir:l <https://www.cms.gov/medicare/coding/place-of-service-codes/place_of_service_code_set.html>
         ] ;
         fhir:code [ fhir:v "24" ] ;
         fhir:display [ fhir:v "Ambulatory Surgical Center" ]
       ] )
     ] ;
     fhir:unitPrice [
       fhir:value [ fhir:v 12500.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v 12500.00 ] ;
       fhir:currency [ fhir:v "USD" ]

     ]
  ];
  fhir:Claim.total [
     fhir:Money.value [ fhir:value "12500.00"^^xsd:decimal ];
     fhir:Money.currency [ fhir:value "USD" ]
  ] .

  ] ) ; # 
  fhir:total [
     fhir:value [ fhir:v 12500.00 ] ;
     fhir:currency [ fhir:v "USD" ]
  ] . # 


<http://hl7.org/fhir/Organization/1> a fhir:Organization .

<http://hl7.org/fhir/Practitioner/example> a fhir:Practitioner .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Claim/MED-00050.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/Claim/MED-00050.ttl> .


# -------------------------------------------------------------------------------------

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.