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STU
3).
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| Responsible Owner: Financial Management Work Group |
|
Compartments : Device , Encounter , Group , Patient , Practitioner , RelatedPerson |
Raw JSON ( canonical form + also see JSON Format Specification )
Simple Pharmacy Medication Claim
Financial
{
"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://hl7.org/fhir/ex-claimtype",
"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": "complete",
"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"
},
"organization": {
"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"
}
],
"information": [
{
"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://hl7.org/fhir/pharmacy-refill",
"code": "new"
}
]
"net" : {
"value" : 45.00,
"currency" : "USD"
}
},
{
"sequence": 2,
"category": {
"coding": [
{
"code": "pharmacyinformation"
}
]
},
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/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://hl7.org/fhir/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,
"careTeamLinkId": [
1
],
"informationLinkId": [
1,
2,
3
],
"service": {
"coding": [
{
"system": "http://hl7.org/fhir/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,
"system": "urn:iso:std:iso:4217",
"code": "USD"
},
"detail": [
{
"sequence": 1,
"service": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-pharmaservice",
"code": "drugcost"
}
]
},
"net": {
"value": 45.00,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"sequence": 2,
"service": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-pharmaservice",
"code": "markup"
}
]
},
"net": {
"value": 9.00,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
},
{
"sequence": 3,
"service": {
"coding": [
{
"system": "http://hl7.org/fhir/ex-pharmaservice",
"code": "dispensefee"
}
]
},
"net": {
"value": 36.00,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}
}
]
}
],
"total": {
"value": 90.00,
"system": "urn:iso:std:iso:4217",
"code": "USD"
}]
}],
"total" : {
"value" : 90.00,
"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.
FHIR
®©
HL7.org
2011+.
FHIR
Release
3
(STU;
v3.0.2-11200)
R6
hl7.fhir.core#6.0.0-ballot3
generated
on
Thurs,
Oct
24,
2019
11:53+1100.
QA
Page
Mon,
Nov
10,
2025
04:55+0000.
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