SOA
Dental
Claim
using
identifiers
and
Contained
{
"resourceType": "Claim",
"id": "100155",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>"
"resourceType" : "Claim",
"id" : "100155",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>"
},
"contained": [
{
"resourceType": "Patient",
"id": "patient-1",
"name": [
{
"use": "official",
"family": "Donald",
"given": [
"Duck"
]
}
],
"gender": "male",
"birthDate": "1986-05-17",
"address": [
{
"use": "home",
"line": [
"1234 Main Street"
],
"city": "Vancouver",
"postalCode": "V2H1Y3",
"country": "CAD"
}
]
}
],
"identifier": [
{
"system": "http://happyvalley.com/claim",
"value": "12347"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "oral"
}
]
"contained" : [{
"resourceType" : "Patient",
"id" : "patient-1",
"name" : [{
"use" : "official",
"family" : "Donald",
"given" : ["Duck"]
}],
"gender" : "male",
"birthDate" : "1986-05-17",
"address" : [{
"use" : "home",
"line" : ["1234 Main Street"],
"city" : "Vancouver",
"postalCode" : "V2H1Y3",
"country" : "CAD"
}]
}],
"identifier" : [{
"system" : "http://happyvalley.com/claim",
"value" : "12347"
}],
"status" : "active",
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "oral"
}]
},
"use": "complete",
"patient": {
"reference": "#patient-1"
"use" : "claim",
"subject" : {
"reference" : "#patient-1"
},
"created": "2014-08-16",
"insurer": {
"identifier": {
"system": "http://www.jurisdiction.com/insurers",
"value": "123456"
"created" : "2014-08-16",
"insurer" : {
"identifier" : {
"system" : "http://www.jurisdiction.com/insurers",
"value" : "123456"
}
},
"organization": {
"identifier": {
"system": "http://www.jurisdiction.com/careorganizations",
"value": "HOSP12345"
"provider" : {
"identifier" : {
"system" : "http://www.jurisdiction.com/careorganizations",
"value" : "HOSP12345"
}
},
"priority": {
"coding": [
{
"code": "normal"
}
]
"priority" : {
"coding" : [{
"code" : "normal"
}]
},
"payee": {
"type": {
"coding": [
{
"code": "provider"
}
]
"payee" : {
"type" : {
"coding" : [{
"code" : "provider"
}]
}
},
"careTeam": [
{
"sequence": 1,
"provider": {
"identifier": {
"system": "http://www.jurisdiction.com/providerId",
"value": "MD98765"
}
"careTeam" : [{
"sequence" : 1,
"provider" : {
"identifier" : {
"system" : "http://www.jurisdiction.com/providerId",
"value" : "MD98765"
}
}
],
"diagnosis": [
{
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"code": "123456"
}
]
}
}],
"diagnosis" : [{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [{
"code" : "123456"
}]
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "http://www.jurisdiction.com/nationalplan/123AB345"
}
}],
"insurance" : [{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "http://www.jurisdiction.com/nationalplan/123AB345"
}
],
"item": [
{
"sequence": 1,
"careTeamLinkId": [
1
],
"service": {
"coding": [
{
"code": "1200"
}
]
},
"servicedDate": "2014-08-16",
"unitPrice": {
"value": 135.57,
"system": "urn:iso:std:iso:4217",
"code": "USD"
},
"net": {
"value": 135.57,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
}],
"item" : [{
"sequence" : 1,
"careTeamSequence" : [1],
"productOrService" : {
"coding" : [{
"code" : "1200"
}]
},
"servicedDate" : "2014-08-16",
"unitPrice" : {
"value" : 135.57,
"currency" : "USD"
},
"net" : {
"value" : 135.57,
"currency" : "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.