Simple Pharmacy Medication Claim

{
  "resourceType": "Claim",
  "id": "760151",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>"

  "resourceType" : "Claim",
  "id" : "760151",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>"

  },
  "identifier": [
    {
      "system": "http://happypharma.com/claim",
      "value": "7612345"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "pharmacy"
      }
    ]

  "identifier" : [{
    "system" : "http://happypharma.com/claim",
    "value" : "7612345"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "pharmacy"
    }]

  },
  "use": "claim",
  "patient": {
    "reference": "Patient/1"

  "use" : "claim",
  "subject" : {
    "reference" : "Patient/1"

  },
  "created": "2014-08-16",
  "insurer": {
    "reference": "Organization/2"

  "created" : "2014-08-16",
  "insurer" : {
    "reference" : "Organization/2"

  },
  "provider": {
    "reference": "Organization/1"

  "provider" : {
    "reference" : "Organization/1"

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

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

  },
  "prescription": {
    "reference": "http://pharmacy.org/MedicationRequest/AB1234G"

  "prescription" : {
    "reference" : "http://pharmacy.org/MedicationRequest/AB1234G"

  },
  "originalPrescription": {
    "reference": "http://pharmacy.org/MedicationRequest/AB1202B"

  "originalPrescription" : {
    "reference" : "http://pharmacy.org/MedicationRequest/AB1202B"

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

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

    }
  },
  "careTeam": [
    {
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/example"
      }

  "careTeam" : [{
    "sequence" : 1,
    "provider" : {
      "reference" : "Practitioner/example"

    }
  ],
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "code": "pharmacyrefill"
          }
        ]

  }],
  "supportingInfo" : [{
    "sequence" : 1,
    "category" : {
      "coding" : [{
        "code" : "pharmacyrefill"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "http://example.org/fhir/CodeSystem/pharmacy-refill",
        "code" : "new"
      }]
    }
  },
  {
    "sequence" : 2,
    "category" : {
      "coding" : [{
        "code" : "pharmacyinformation"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "http://example.org/fhir/CodeSystem/pharmacy-information",
        "code" : "refillsremaining"
      }]
    },
    "valueQuantity" : {
      "value" : 2
    }
  },
  {
    "sequence" : 3,
    "category" : {
      "coding" : [{
        "code" : "pharmacyinformation"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "http://example.org/fhir/CodeSystem/pharmacy-information",
        "code" : "dayssupply"
      }]
    },
    "valueQuantity" : {
      "value" : 90
    }
  }],
  "diagnosis" : [{
    "sequence" : 1,
    "diagnosisCodeableConcept" : {
      "coding" : [{
        "code" : "654456"
      }]
    }
  }],
  "insurance" : [{
    "sequence" : 1,
    "focal" : true,
    "coverage" : {
      "reference" : "Coverage/9876B1"
    }
  }],
  "item" : [{
    "sequence" : 1,
    "careTeamSequence" : [1],
    "informationSequence" : [1,
    2,
    3],
    "productOrService" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "562721",
        "display" : "amylase / cellulase / hyoscyamine / lipase / phenyltoloxamine / protease Oral Capsule"
      }]
    },
    "servicedDate" : "2014-08-16",
    "quantity" : {
      "value" : 90,
      "unit" : "TAB",
      "system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
      "code" : "TAB"
    },
    "net" : {
      "value" : 90.00,
      "currency" : "USD"
    },
    "detail" : [{
      "sequence" : 1,
      "productOrService" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/ex-pharmaservice",
          "code" : "drugcost"
        }]

      },
      "code": {
        "coding": [
          {
            "system": "http://example.org/fhir/CodeSystem/pharmacy-refill",
            "code": "new"
          }
        ]

      "net" : {
        "value" : 45.00,
        "currency" : "USD"

      }
    },
    {
      "sequence": 2,
      "category": {
        "coding": [
          {
            "code": "pharmacyinformation"
          }
        ]
      },
      "code": {
        "coding": [
          {
            "system": "http://example.org/fhir/CodeSystem/pharmacy-information",
            "code": "refillsremaining"
          }
        ]

      "sequence" : 2,
      "productOrService" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/ex-pharmaservice",
          "code" : "markup"
        }]

      },
      "valueQuantity": {
        "value": 2

      "net" : {
        "value" : 9.00,
        "currency" : "USD"

      }
    },
    {
      "sequence": 3,
      "category": {
        "coding": [
          {
            "code": "pharmacyinformation"
          }
        ]
      },
      "code": {
        "coding": [
          {
            "system": "http://example.org/fhir/CodeSystem/pharmacy-information",
            "code": "dayssupply"
          }
        ]

      "sequence" : 3,
      "productOrService" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/ex-pharmaservice",
          "code" : "dispensefee"
        }]

      },
      "valueQuantity": {
        "value": 90
      }
    }
  ],
  "diagnosis": [
    {
      "sequence": 1,
      "diagnosisCodeableConcept": {
        "coding": [
          {
            "code": "654456"
          }
        ]
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true,
      "coverage": {
        "reference": "Coverage/9876B1"

      "net" : {
        "value" : 36.00,
        "currency" : "USD"

      }
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "informationSequence": [
        1,
        2,
        3
      ],
      "productOrService": {
        "coding": [
          {
            "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code": "562721",
            "display": "Alprazolam 0.25mg (Xanax)"
          }
        ]
      },
      "servicedDate": "2014-08-16",
      "quantity": {
        "value": 90,
        "unit": "TAB",
        "system": "http://unitsofmeasure.org",
        "code": "TAB"
      },
      "net": {
        "value": 90.00,
        "currency": "USD"
      },
      "detail": [
        {
          "sequence": 1,
          "productOrService": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/ex-pharmaservice",
                "code": "drugcost"
              }
            ]
          },
          "net": {
            "value": 45.00,
            "currency": "USD"
          }
        },
        {
          "sequence": 2,
          "productOrService": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/ex-pharmaservice",
                "code": "markup"
              }
            ]
          },
          "net": {
            "value": 9.00,
            "currency": "USD"
          }
        },
        {
          "sequence": 3,
          "productOrService": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/ex-pharmaservice",
                "code": "dispensefee"
              }
            ]
          },
          "net": {
            "value": 36.00,
            "currency": "USD"
          }
        }
      ]
    }
  ],
  "total": {
    "value": 90.00,
    "currency": "USD"

    }]
  }],
  "total" : {
    "value" : 90.00,
    "currency" : "USD"

  }
}