Release 4 5 Ballot

This page is part of the FHIR Specification (v4.0.1: R4 (v5.0.0-ballot: R5 Ballot - Mixed Normative and STU see ballot notes ) in it's permanent home (it will always be available at this URL). ). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Patient-example-c.xml

Example PaymentNotice/77654 (JSON)

Patient Administration Financial Management Work Group Maturity Level : N/A Standards Status : Informative Compartments : Patient , Practitioner , RelatedPerson

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

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Deceased patient (using time) (id = "pat3") Claim PaymentNotice Example

<?xml version="1.0" encoding="UTF-8"?> </ Patient > 
{
  "resourceType": "PaymentNotice",
  "id": "77654",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentNotice</div>"
  },
  "identifier": [
    {
      "system": "http://benefitsinc.com/paymentnotice",
      "value": "776543"
    }
  ],
  "status": "active",
  "request": {
    "reference": "http://benefitsinc.com/fhir/claim/12345"
  },
  "response": {
    "reference": "http://benefitsinc.com/fhir/claimresponse/CR12345"
  },
  "created": "2014-08-16",
  "provider": {
    "reference": "Organization/1"
  },
  "payment": {
    "reference": "PaymentReconciliation/ER2500"
  },
  "paymentDate": "2014-08-15",
  "payee": {
    "reference": "Organization/1"
  },
  "recipient": {
    "identifier": {
      "system": "http://regulators.gov",
      "value": "AB123"
    }
  },
  "amount": {
    "value": 12500.00,
    "currency": "USD"
  },
  "paymentStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/paymentstatus",
        "code": "paid"
      }
    ]
  }
}

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.