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 R2

Claim-example-oral-contained.json

Example Claim/100152 (JSON)

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

Raw JSON ( canonical form + also see JSON Format Specification )

SOA Dental Claim (Contained) 

{
  "resourceType": "Claim",
  "id": "100152",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"

  "resourceType" : "Claim",
  "id" : "100152",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Oral Health Claim</div>"

  },
  "contained": [
    {
      "resourceType": "Organization",
      "id": "org-insurer",
      "identifier": [
        {
          "system": "http://www.bindb.com/bin",
          "value": "123456"
        }
      ]

  "contained" : [{
    "resourceType" : "Organization",
    "id" : "org-insurer",
    "identifier" : [{
      "system" : "http://www.bindb.com/bin",
      "value" : "123456"
    }]
  },
  {
    "resourceType" : "Organization",
    "id" : "org-org",
    "identifier" : [{
      "system" : "http://www.jurisdiction.com/oralhealthoffices",
      "value" : "3456"
    }]
  },
  {
    "resourceType" : "Practitioner",
    "id" : "provider-1",
    "identifier" : [{
      "system" : "http://www.jurisdiction.com/oralhealthproviders",
      "value" : "123456789"
    }]
  },
  {
    "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"
    }]
  },
  {
    "resourceType" : "Coverage",
    "id" : "coverage-1",
    "identifier" : [{
      "system" : "http://benefitsinc.com/certificate",
      "value" : "12345"
    }],
    "status" : "active",
    "kind" : "insurance",
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code" : "EHCPOL"
      }]

    },
    {
      "resourceType": "Organization",
      "id": "org-org",
      "identifier": [
        {
          "system": "http://www.jurisdiction.com/oralhealthoffices",
          "value": "3456"
        }
      ]

    "subscriber" : {
      "reference" : "#patient-1"

    },
    {
      "resourceType": "Practitioner",
      "id": "provider-1",
      "identifier": [
        {
          "system": "http://www.jurisdiction.com/oralhealthproviders",
          "value": "123456789"
        }
      ]

    "beneficiary" : {
      "reference" : "#patient-1"

    },
    {
      "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"
        }
      ]

    "dependent" : "1",
    "relationship" : {
      "coding" : [{
        "code" : "self"
      }]

    },
    {
      "resourceType": "Coverage",
      "id": "coverage-1",
      "identifier": [
        {
          "system": "http://benefitsinc.com/certificate",
          "value": "12345"
        }
      ],
      "status": "active",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code": "EHCPOL"
          }
        ]

    "insurer" : {
      "identifier" : {
        "system" : "http://www.bindb.com/bin",
        "value" : "123456"
      }
    },
    "class" : [{
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "plan"
        }]

      },
      "subscriber": {
        "reference": "#patient-1"

      "value" : {
        "value" : "CBI35"

      },
      "beneficiary": {
        "reference": "#patient-1"

      "name" : "Corporate Baker's Inc. Plan#35"
    },
    {
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "subplan"
        }]

      },
      "dependent": "1",
      "relationship": {
        "coding": [
          {
            "code": "self"
          }
        ]

      "value" : {
        "value" : "123"

      },
      "payor": [
        {
          "identifier": {
            "system": "http://www.bindb.com/bin",
            "value": "123456"
          }
        }
      ],
      "class": [
        {
          "type": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code": "plan"
              }
            ]
          },
          "value": "CBI35",
          "name": "Corporate Baker's Inc. Plan#35"
        },
        {
          "type": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code": "subplan"
              }
            ]
          },
          "value": "123",
          "name": "Trainee Part-time Benefits"
        },
        {
          "type": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                "code": "sequence"
              }
            ]
          },
          "value": "1"
        }
      ]
    }
  ],
  "identifier": [

      "name" : "Trainee Part-time Benefits"
    },

    {
      "system": "http://happyvalley.com/claim",
      "value": "12347"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "oral"

      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "sequence"
        }]
      },
      "value" : {
        "value" : "1"

      }
    ]

    }]
  }],
  "identifier" : [{
    "system" : "http://happyvalley.com/claim",
    "value" : "12347"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "oral"
    }]

  },
  "use": "claim",
  "patient": {
    "reference": "#patient-1"

  "use" : "claim",
  "subject" : {
    "reference" : "#patient-1"

  },
  "created": "2014-08-16",
  "insurer": {
    "reference": "#org-insurer"

  "created" : "2014-08-16",
  "insurer" : {
    "reference" : "#org-insurer"

  },
  "provider": {
    "reference": "#org-org"

  "provider" : {
    "reference" : "#org-org"

  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]

  "priority" : {
    "coding" : [{
      "code" : "normal"
    }]

  },
  "payee": {
    "type": {
      "coding": [
        {
          "code": "provider"
        }
      ]

  "payee" : {
    "type" : {
      "coding" : [{
        "code" : "provider"
      }]

    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "#provider-1"
      }

  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "reference" : "#provider-1"

    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "123456"
          }
        ]
      }

  }],
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "code" : "123456"
      }]

    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "#coverage-1"
      }

  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "reference" : "#coverage-1"

    }
  ],
  "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"
      }

  }],
  "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.