Release 4B R5 Final QA

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0-draft-final: Final QA Preview for R5 - STU see ballot notes ). 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

Claim-example-pharmacy-compound.xml

Example Claim/760152 (XML)

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

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

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Simple Pharmacy Compound Claim (id = "760152")

<?xml version="1.0" encoding="UTF-8"?> 
<?xml version="1.0" encoding="UTF-8"?>
<Claim xmlns="http://hl7.org/fhir">  <id value="760152"/>   <text>     <status value="generated"/>     <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Pharmacy Claim</div>   </text>   <identifier>     <system value="http://happypharma.com/claim"/>     <value value="7612345"/>   </identifier>   <status value="active"/>   <type>     <coding>       <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>       <code value="pharmacy"/>     </coding>     </type>   <use value="claim"/>   <patient>     <reference value="Patient/1"/>   </patient>   <created value="2014-08-16"/>   <insurer>     <reference value="Organization/2"/>   </insurer>   <provider>     <reference value="Organization/1"/>   </provider>   <priority>     <coding>       <code value="stat"/>     </coding>   </priority>   <payee>     <type>       <coding>         <code value="provider"/>       </coding>     </type>   </payee>   <careTeam>     <sequence value="1"/>     <provider>       <reference value="Practitioner/example"/>     </provider>   </careTeam>   <supportingInfo>     <sequence value="1"/>     <category>       <coding>         <code value="pharmacyrefill"/>       </coding>     </category>     <code>       <coding>         <system value="http://example.org/fhir/CodeSystem/pharmacy-refill"/>         <code value="new"/>       </coding>     </code>     </supportingInfo>   <supportingInfo>     <sequence value="2"/>     <category>       <coding>         <code value="pharmacyinformation"/>       </coding>     </category>     <code>       <coding>         <system value="http://example.org/fhir/CodeSystem/pharmacy-information"/>         <code value="refillsremaining"/>       </coding>     </code>       <valueQuantity>       <value value="0"/>     </valueQuantity>   </supportingInfo>   <supportingInfo>     <sequence value="3"/>     <category>       <coding>         <code value="pharmacyinformation"/>       </coding>     </category>     <code>       <coding>         <system value="http://example.org/fhir/CodeSystem/pharmacy-information"/>         <code value="dayssupply"/>       </coding>     </code>       <valueQuantity>       <value value="10"/>     </valueQuantity>   </supportingInfo>   <supportingInfo>     <sequence value="4"/>     <category>       <coding>         <code value="pharmacy"/>       </coding>     </category>     <code>       <coding>         <system value="http://example.org/fhir/CodeSystem/pharmacy-form"/>         <code value="capsule"/>       </coding>     </code>     </supportingInfo>   <diagnosis>     <sequence value="1"/>     <diagnosisCodeableConcept>       <coding>         <code value="654456"/>       </coding>     </diagnosisCodeableConcept>   </diagnosis>   <insurance>     <sequence value="1"/>     <focal value="true"/>     <coverage>       <reference value="Coverage/9876B1"/>     </coverage>   </insurance>   <item>     <sequence value="1"/>     <careTeamSequence value="1"/>     <informationSequence value="1"/>     <informationSequence value="2"/>     <informationSequence value="3"/>     <informationSequence value="4"/>       <!--   type=compoundmedication   -->    <productOrService>       <coding>         <system value="http://localdruglist.org"/>         <code value="compound"/>          <display value="Custom compound"/>       </coding>      </productOrService>     <servicedDate value="2014-08-16"/>     <quantity>       <value value="30"/>       <unit value="TAB"/>       <system value="http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"/>        <code value="TAB"/>     </quantity>     <net>       <value value="155.00"/>       <currency value="USD"/>      </net>      <detail>       <sequence value="1"/>         <!--   type=packagemedication   -->      <productOrService>         <coding>           <system value="http://localdruglist.org"/>           <code value="44001"/>            <display value="Acetaminophen 250mg"/>         </coding>        </productOrService>       <quantity>         <value value="250"/>         <unit value="mg"/>       </quantity>       <net>         <value value="20.00"/>         <currency value="USD"/>        </net>          <subDetail>         <sequence value="1"/>           <!--   type=costitem   -->        <productOrService>           <coding>             <system value="http://hl7.org/fhir/ex-pharmaservice"/>             <code value="drugcost"/>            </coding>          </productOrService>         <net>           <value value="20.00"/>           <currency value="USD"/>          </net>        </subDetail>     </detail>     <detail>       <sequence value="2"/>         <!--   type=packagemedication   -->      <productOrService>         <coding>           <system value="http://localdruglist.org"/>           <code value="44035"/>            <display value="Phenacetin 50mg"/>         </coding>        </productOrService>       <quantity>         <value value="50"/>         <unit value="mg"/>       </quantity>       <net>         <value value="25.00"/>         <currency value="USD"/>        </net>          <subDetail>         <sequence value="1"/>           <!--   type=costitem   -->        <productOrService>           <coding>             <system value="http://hl7.org/fhir/ex-pharmaservice"/>             <code value="drugcost"/>            </coding>          </productOrService>         <net>           <value value="25.00"/>           <currency value="USD"/>          </net>        </subDetail>     </detail>     <detail>       <sequence value="3"/>         <!--   type=packagemedication   -->      <productOrService>         <coding>           <system value="http://localdruglist.org"/>           <code value="44057"/>            <display value="Codeine 25mg"/>         </coding>        </productOrService>       <quantity>         <value value="25"/>         <unit value="mg"/>       </quantity>       <net>         <value value="28.00"/>         <currency value="USD"/>        </net>          <subDetail>         <sequence value="1"/>           <!--   type=costitem   -->        <productOrService>           <coding>             <system value="http://hl7.org/fhir/ex-pharmaservice"/>             <code value="drugcost"/>            </coding>          </productOrService>         <net>           <value value="28.00"/>           <currency value="USD"/>          </net>        </subDetail>     </detail>     <detail>       <sequence value="2"/>         <!--   type=costitem   -->      <productOrService>         <coding>           <system value="http://hl7.org/fhir/ex-pharmaservice"/>           <code value="markup"/>          </coding>        </productOrService>       <net>         <value value="22.00"/>         <currency value="USD"/>        </net>      </detail>     <detail>       <sequence value="3"/>         <!--   type=costitem   -->      <productOrService>         <coding>           <system value="http://hl7.org/fhir/ex-pharmaservice"/>           <code value="compoundfee"/>          </coding>        </productOrService>       <net>         <value value="60.00"/>         <currency value="USD"/>        </net>      </detail>   </item>   <total>     <value value="155.00"/>     <currency value="USD"/>    </total> 


</

Claim

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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.