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 R3

Claim-example-oral-average.ttl

Example Claim/100151 (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 )

Average dental Claim with Information (Missing Teeth and Student) 

@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/100151> a fhir:Claim;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "100151"];
  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 the Oral Health Claim</div>"
  ];
  fhir:Claim.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "http://happyvalley.com/claim" ];
     fhir:Identifier.value [ fhir:value "12346" ]
  ];
  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 "oral" ]
     ]
  ];
  fhir:Claim.use [ fhir:value "claim"];
  fhir:Claim.patient [
     fhir:link <http://hl7.org/fhir/Patient/1>;
     fhir:Reference.reference [ fhir:value "Patient/1" ]
  ];
  fhir:Claim.created [ fhir:value "2014-08-16"^^xsd:date];
  fhir:Claim.insurer [
     fhir:link <http://hl7.org/fhir/Organization/2>;
     fhir:Reference.reference [ fhir:value "Organization/2" ]
  ];
  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.code [ fhir:value "provider" ]
       ]

<http://hl7.org/fhir/Claim/100151> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "100151"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
     fhir:system [
       fhir:v "http://happyvalley.com/claim"^^xsd:anyURI ;
       fhir:l <http://happyvalley.com/claim>
     ] ;
     fhir:value [ fhir:v "12346" ]
  ] ) ; # 
  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 "oral" ]
     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:subject [
     fhir:l <http://hl7.org/fhir/Patient/1> ;
     fhir:reference [ fhir:v "Patient/1" ]
  ] ; # 
  fhir:created [ fhir:v "2014-08-16"^^xsd:date] ; # 
  fhir:insurer [
     fhir:l <http://hl7.org/fhir/Organization/2> ;
     fhir:reference [ fhir:v "Organization/2" ]
  ] ; # 
  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:code [ fhir:v "provider" ]
       ] )

     ]
  ];
  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 "missingtooth" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-tooth" ];
         fhir:Coding.code [ fhir:value "15" ]
       ]
     ];
     fhir:Claim.supportingInfo.timingDate [ fhir:value "2012-04-07"^^xsd:date ];
     fhir:Claim.supportingInfo.reason [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/missingtoothreason" ];
         fhir:Coding.code [ fhir:value "e" ]
       ]

  ] ) ; # 
  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 "missingtooth" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/ex-tooth"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/ex-tooth>
         ] ;
         fhir:code [ fhir:v "15" ]
       ] )
     ] ;
     fhir:timing [
       a fhir:DateTime ;
       fhir:v "2012-04-07"^^xsd:date
     ] ;
     fhir:reason [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/missingtoothreason"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/missingtoothreason>
         ] ;
         fhir:code [ fhir:v "e" ]
       ] ) #   Extraction  

     ]
  ], [
     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 "exception" ]
       ]
     ];
     fhir:Claim.supportingInfo.code [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-exception" ];
         fhir:Coding.code [ fhir:value "student" ]
       ]
     ];
     fhir:Claim.supportingInfo.valueString [ fhir:value "Happy Valley Community College" ]
  ];
  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.code [ fhir:value "123456" ]
       ]

  ] [
     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 "exception" ]
       ] )
     ] ;
     fhir:code [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://terminology.hl7.org/CodeSystem/claim-exception"^^xsd:anyURI ;
           fhir:l <http://terminology.hl7.org/CodeSystem/claim-exception>
         ] ;
         fhir:code [ fhir:v "student" ]
       ] )
     ] ;
     fhir:value [
       a fhir:String ;
       fhir:v "Happy Valley Community College"

     ]
  ];
  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.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/9876B1>;
       fhir:Reference.reference [ fhir:value "Coverage/9876B1" ]

  ] ) ; # 
  fhir:diagnosis ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:diagnosis [
       a fhir:CodeableConcept ;
       fhir:coding ( [
         fhir:code [ fhir:v "123456" ]
       ] )

     ]
  ];
  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.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "1200" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "135.57"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "135.57"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]

  ] ) ; # 
  fhir:insurance ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:focal [ fhir:v true ] ;
     fhir:coverage [
       fhir:l <http://hl7.org/fhir/Coverage/9876B1> ;
       fhir:reference [ fhir:v "Coverage/9876B1" ]

     ]
  ], [
     fhir:index 1;
     fhir:Claim.item.sequence [ fhir:value "2"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "21211" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "105.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.bodySite [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
         fhir:Coding.code [ fhir:value "21" ]
       ]
     ];
     fhir:Claim.item.subSite [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oralsurfacecodes" ];
         fhir:Coding.code [ fhir:value "L" ]
       ]

  ] ) ; # 
  fhir:item ( [
     fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ;
           fhir:l <http://example.org/fhir/oralservicecodes>
         ] ;
         fhir:code [ fhir:v "1200" ]
       ] )
     ] ;
     fhir:serviced [
       a fhir:Date ;
       fhir:v "2014-08-16"^^xsd:date
     ] ;
     fhir:unitPrice [
       fhir:value [ fhir:v 135.57 ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v 135.57 ] ;
       fhir:currency [ fhir:v "USD" ]

     ]
  ], [
     fhir:index 2;
     fhir:Claim.item.sequence [ fhir:value "3"^^xsd:positiveInteger ];
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger;
       fhir:index 0
     ];
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
         fhir:Coding.code [ fhir:value "27211" ]
       ]
     ];
     fhir:Claim.item.servicedDate [ fhir:value "2014-08-16"^^xsd:date ];
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "1100.00"^^xsd:decimal ];
       fhir:Money.currency [ fhir:value "USD" ]
     ];
     fhir:Claim.item.bodySite [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://fdi.org/fhir/oraltoothcodes" ];
         fhir:Coding.code [ fhir:value "36" ]
       ]
     ];
     fhir:Claim.item.detail [
       fhir:index 0;
       fhir:Claim.item.detail.sequence [ fhir:value "1"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "27211" ]

  ] [
     fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ;
           fhir:l <http://example.org/fhir/oralservicecodes>
         ] ;
         fhir:code [ fhir:v "21211" ]
       ] )
     ] ;
     fhir:serviced [
       a fhir:Date ;
       fhir:v "2014-08-16"^^xsd:date
     ] ;
     fhir:unitPrice [
       fhir:value [ fhir:v 105.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v 105.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:bodySite ( [
       fhir:site ( [
         fhir:concept [
           fhir:coding ( [
             fhir:system [
               fhir:v "http://fdi.org/fhir/oraltoothcodes"^^xsd:anyURI ;
               fhir:l <http://fdi.org/fhir/oraltoothcodes>
             ] ;
             fhir:code [ fhir:v "21" ]
           ] )

         ]
       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "1000.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.factor [ fhir:value "0.75"^^xsd:decimal ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "750.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ]
     ], [
       fhir:index 1;
       fhir:Claim.item.detail.sequence [ fhir:value "2"^^xsd:positiveInteger ];
       fhir:Claim.item.detail.productOrService [
         fhir:CodeableConcept.coding [
           fhir:index 0;
           fhir:Coding.system [ fhir:value "http://example.org/fhir/oralservicecodes" ];
           fhir:Coding.code [ fhir:value "lab" ]

       ] ) ;
       fhir:subSite ( [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://fdi.org/fhir/oralsurfacecodes"^^xsd:anyURI ;
             fhir:l <http://fdi.org/fhir/oralsurfacecodes>
           ] ;
           fhir:code [ fhir:v "L" ]
         ] )
       ] )
     ] )
  ] [
     fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
     fhir:careTeamSequence ( [ fhir:v "1"^^xsd:positiveInteger ] ) ;
     fhir:productOrService [
       fhir:coding ( [
         fhir:system [
           fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ;
           fhir:l <http://example.org/fhir/oralservicecodes>
         ] ;
         fhir:code [ fhir:v "27211" ]
       ] )
     ] ;
     fhir:serviced [
       a fhir:Date ;
       fhir:v "2014-08-16"^^xsd:date
     ] ;
     fhir:unitPrice [
       fhir:value [ fhir:v 1100.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:net [
       fhir:value [ fhir:v 1100.00 ] ;
       fhir:currency [ fhir:v "USD" ]
     ] ;
     fhir:bodySite ( [
       fhir:site ( [
         fhir:concept [
           fhir:coding ( [
             fhir:system [
               fhir:v "http://fdi.org/fhir/oraltoothcodes"^^xsd:anyURI ;
               fhir:l <http://fdi.org/fhir/oraltoothcodes>
             ] ;
             fhir:code [ fhir:v "36" ]
           ] )

         ]
       ];
       fhir:Claim.item.detail.unitPrice [
         fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]
       ];
       fhir:Claim.item.detail.net [
         fhir:Money.value [ fhir:value "350.00"^^xsd:decimal ];
         fhir:Money.currency [ fhir:value "USD" ]

       ] )
     ] ) ;
     fhir:detail ( [
       fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ;
             fhir:l <http://example.org/fhir/oralservicecodes>
           ] ;
           fhir:code [ fhir:v "27211" ]
         ] )
       ] ;
       fhir:unitPrice [
         fhir:value [ fhir:v 1000.00 ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:factor [ fhir:v 0.75 ] ;
       fhir:net [
         fhir:value [ fhir:v 750.00 ] ;
         fhir:currency [ fhir:v "USD" ]
       ] #   Student discount  
     ] [
       fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
       fhir:productOrService [
         fhir:coding ( [
           fhir:system [
             fhir:v "http://example.org/fhir/oralservicecodes"^^xsd:anyURI ;
             fhir:l <http://example.org/fhir/oralservicecodes>
           ] ;
           fhir:code [ fhir:v "lab" ]
         ] )
       ] ;
       fhir:unitPrice [
         fhir:value [ fhir:v 350.00 ] ;
         fhir:currency [ fhir:v "USD" ]
       ] ;
       fhir:net [
         fhir:value [ fhir:v 350.00 ] ;
         fhir:currency [ fhir:v "USD" ]

       ]
     ]
  ] .

     ] )
  ] ) . # 


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

<http://hl7.org/fhir/Organization/2> a fhir:Organization .

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

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

<http://hl7.org/fhir/Coverage/9876B1> a fhir:Coverage .

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

<http://hl7.org/fhir/Claim/100151.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/Claim/100151.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.